Fillable Department of Allied Health, Mental Health and Human (CUNY Kingsborough Community College)

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Department of Allied Health, Mental Health and Human (CUNY Kingsborough Community College)

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KINGSBOROUGH COMMUNITY COLLEGE
Department of Allied Health, Mental Health and Human Services
Major: Surgical Technology (A.A.S.)
Application – Effective Summer 2020
Application Checklist and Directions
NOTE: Students applying to the Surgical Technology program must be KBCC registered students or have submitted
official school transcripts to Registrar’s office prior application to our program.
• Students must have completed pre-requisite courses ENG 12 and BIO 11 with at least a minimum grade of C
before applying to the program and have achieved a minimum overall GPA of 2.5.
• Courses transferred from other colleges to be applied toward program requirements with a minimum of C
must be submitted to the school prior application.
• Students can earn additional points for admission based upon a final course grade of C or higher in BIO 12,
BIO 51, ENG 24, MAT 4A0, PHI 7600, PSY 1100, SOC 3100, so it is greatly encouraged to students enroll
in these courses prior applying to the program.
• Students that are not meeting the minimum requirements at the time of application and would like to be
considered in the future will be required to meet with your academic counselor at
Health Sciences and Stem
Academy for guidance or contact the Surgical Program director for further advise.
Date:
First Application
□
Re-Application
□
Transfer School:
Last Name:
First:
School ID #:
Email:
Address:
City:
State:
Zip:
US Citizenship, Permanent residency or
International Student w/ F-1 visa: Yes □ No □
Home Phone:
SSN: Last 4 Digits
Mobile Phone:
COURSE REQUIREMENTS (ENG 12 and BIO 11 are the only pre-requisites for entry into the program) Overall GPA: ____
COURSE GRADE COURSE GRADE COURSE GRADE
English 12 Yes
□
No
□
Bio 11 Yes
□
No
□
Bio 12 Yes
□
No
□
Math 4A0 Yes
□
No
□
PHI 7600 Yes
□
No
□
Bio 51 Yes
□
No
□
Psy 1100 Yes
□
No
□
Soc 3100 Yes
□
No
□
Other:
ACADEMIC BACKGROUND
Please check your highest level of Education: HS □ Associates □ Bachelors □ Master □ Diploma/Certificate □
Name of school you received your previous education/degree? Year obtained:
In what subject was your previous academic degree/certificate/diploma?
For further information you may email the Surgical Technology Program Director jorge.zamudio@kbcc.cuny.edu, or
call to (718) 368-5522 for an appointment.
I certify that the attached application related items are correct and accurate. I understand that the falsification of any
information or documentation will result in the revocation of this application.
Applicant Signature __________________________________________Date __________
Jz/20
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Department of Allied Health, Mental Health and Human (CUNY Kingsborough Community College)

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Completed 26 July 2020

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