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Szgljwyǯaÿ9}A/>? x_}`Wa8_r$#ɸ($? Cܛ-GH]&w^n~<.mGj^l~OnoΆav:QIzď$;|>@AL(G*}$TRg;d]u_o?eוMi|o;~"6G{^Ue{*fxwff[㓏//tT)q!lV22:{[Uf%^M[,OъⷾlDY]^58lɝ'!Q厊!a0A7EZ΀mQ 4W~U9'+:؏O.CFYZVUүe}%$xkrgkK SBB:DyU޴T8Ŏ?ϷEm-n.3I'c鹿N=815\FM}[*dϯvStR~ !Bڑ?~+Iӈ>˳&Ը*V͝P edY 1)j뮗_ 6 JsYa0У cj!4`+pZs[nZ]b(}KV@@hbShwm)asꮷY vk)3qN͌-N #EgT aJPhx:/i2 րg3„I0 Hfۓ!NVxSz D]׺Kd?GwVk܎cnVۈ# uv;4Q%0QUl vJD ԟ!v Vػ7zqt\4 C`П}UU`؉`*,ұ?w;˜ b$d~C?z8D4cʕz6z'K qU/dXʫ<]݈Cʓv|Wױ$q@d> $x4{6t66>ħA֞9:Y!ݱg&2,ފİϲԛϴw;%Qe<}cd V)/KۦNI,Nz"[X($NCM+y)B!Rtx] le%uE}dYR{a+?P!T8! 'DEX&ǵAk! v|X+ˡ:meˣTf +/PPư`Jμ.o9mKYTvԂj%rPY-Sbֳ%-@쮐 mG (z?cQᘊ& JM͔H(vUΧi,RA'X('\@̯Hg+`ũufтb-ZxC'֡&QkN-8j a0\ Ԧ5{X]fKǚ@Y9l_Un;'71[ni$b= P z2MM6I$!rP[\طsGJ|4d~U}t!ӭ2~-ODIY4Uq M"QRoUt%oT?10A(vl`|RLOrx/O*Щ$}Ra yx/N,)vOkؙ>F?š1VyӮh A@|ASR_KES|``yL)} NN58栩 W (җE[/fj<[S#p}ASS QFt}jE5EGVCDVTNL$̡{SG:$$v&BI4l>}{5ΘTzkԴz=0ЪKy$@7/RuYmP= CTqnş߭UʪN8k_*LmQKӷլ0aָMқki.J-WB5&YB̤]WBu ~3JVש:ľ [X{š;uWx/_BWf7k);bS'>eSpݝV4kCWΧXk(bcdQeD '89~dV=vՊȘ /"ӏ؉O@H;,1 |lv"=kb2g@ˮhb2X,WD"]׽a5 >[(adUGDhcgi;F-E@lũ]OeTZ~gDAiO%ɈXof{xFwDR/*&UwA 'An␂@UssY_gL NN}#=b[:y>F*mcO, "whq1Mv#]ZՉ-vMkCkfa IY&Ʀ/:%V܌i;!vRwC1BwMʖQw3U,Ƃ|MkfEc=%d!dV0{PU*sT:s a1-ʹ<oe*L*~HP$gk1;nn'՚\/@iImO=X㷾KEBX?#BZ(\\$ DkRV:?p̦Z:?xH@'_9W߰  e,ţ$r(>?8uEdΜ",w7wǹ"e-;u~#\">fEl )!G\ ߣWy'}WU놣.o.D@<*ϋ|TE&BB$r!Pw!'isk>]zу\'܋F9Ovp4c6fdo$Bj!` 'Zb)ӘIX,%`AAXJ >ad .3.7DprVdK44΅U5t3]`btq"9UKX:z$Dn6@lue7-1݄ $*YY91ח\HA&F/wإAƻ/#=l'X;sBQ#t@ܶ[4&Wz4Ј0Qfxz;ҳOEtB*r"αOX3CS- ~@lgu& F`#Õ .oĜ$~"-'>BN.` k+r%ftG-3YNf S [ߘ tb b NJfk[EAznTC!H.e!DzV+U#Yfes.GICQz^G3'aА7IH`p(NڭUc OE22nJMD%A N\] -Ra7ZUztY혬2 |bgRH3:ƑNa,[d3d4<$ d`뿉wMmj;W|"F[CZKK#:Y ]eio!.K4I#'Wf*y24MOby 5 G.v" k;07g'U_K1_OL_J%U%zL0)=W}%_r]dj1L)+ ih<2'O%H0&^ф|M deuɶd-3Z\"Oh3sv9𘌽P\.6lz%z_vUSx}Fd"li{H%0֑npC//S8 [ ċ"p̎k9Giìy͠ssb8u[2| #n3QZ|:vr*YYBtϥzO#U؁9s=k ){äfG/?4ü}>(= ?axqR|`[ endstream endobj 32 0 obj << /Type /Outlines >> endobj 33 0 obj << /Count 9 /Kids [333 0 R 1 0 R 3 0 R 11 0 R 13 0 R 18 0 R 20 0 R 22 0 R 24 0 R] /Type /Pages >> endobj 34 0 obj [333 0 R /XYZ null null null] endobj 35 0 obj << /Length 797 /Subtype /XML /Type /Metadata >> stream Dynamic Forms Document 1 endstream endobj 36 0 obj << /K [37 0 R] /ParentTree 319 0 R /ParentTreeNextKey 9 /Type /StructTreeRoot >> endobj 37 0 obj << /K [38 0 R 39 0 R 41 0 R 43 0 R 44 0 R 45 0 R 46 0 R 48 0 R 49 0 R 50 0 R 51 0 R 52 0 R 53 0 R 54 0 R 55 0 R 56 0 R 57 0 R 58 0 R 59 0 R 60 0 R 61 0 R 63 0 R 64 0 R 66 0 R 67 0 R 68 0 R 69 0 R 70 0 R 71 0 R 73 0 R 74 0 R 75 0 R 76 0 R 77 0 R 78 0 R 79 0 R 80 0 R 81 0 R 82 0 R 83 0 R 84 0 R 85 0 R 86 0 R 87 0 R 88 0 R 89 0 R 90 0 R 91 0 R 92 0 R 93 0 R 94 0 R 95 0 R 96 0 R 97 0 R 98 0 R 99 0 R 100 0 R 101 0 R 102 0 R 103 0 R 104 0 R 106 0 R 108 0 R 109 0 R 110 0 R 112 0 R 113 0 R 114 0 R 115 0 R 116 0 R 118 0 R 119 0 R 120 0 R 121 0 R 122 0 R 123 0 R 125 0 R 126 0 R 127 0 R 128 0 R 129 0 R 130 0 R 131 0 R 132 0 R 133 0 R 134 0 R 135 0 R 136 0 R 138 0 R 139 0 R 140 0 R 141 0 R 142 0 R 143 0 R 144 0 R 145 0 R 146 0 R 148 0 R 149 0 R 150 0 R 151 0 R 152 0 R 153 0 R 154 0 R 155 0 R 156 0 R 157 0 R 158 0 R 159 0 R 160 0 R 162 0 R 164 0 R 166 0 R 167 0 R 168 0 R 170 0 R 171 0 R 173 0 R 174 0 R 175 0 R 177 0 R 178 0 R 179 0 R 180 0 R 181 0 R 183 0 R 184 0 R 185 0 R 186 0 R 187 0 R 188 0 R 189 0 R 190 0 R 191 0 R 192 0 R 193 0 R 194 0 R 195 0 R 196 0 R 197 0 R 198 0 R 200 0 R 201 0 R 202 0 R 203 0 R 205 0 R 206 0 R 207 0 R 208 0 R 209 0 R 210 0 R 211 0 R 212 0 R 213 0 R 214 0 R 215 0 R 216 0 R 217 0 R 219 0 R 220 0 R 221 0 R 222 0 R 223 0 R 224 0 R 225 0 R 226 0 R 227 0 R 228 0 R 229 0 R 230 0 R 231 0 R 232 0 R 233 0 R 234 0 R 236 0 R 237 0 R 238 0 R 239 0 R 240 0 R 241 0 R 242 0 R 243 0 R 244 0 R 245 0 R 246 0 R 247 0 R 248 0 R 249 0 R 250 0 R 252 0 R 253 0 R 254 0 R 255 0 R 256 0 R 257 0 R 258 0 R 259 0 R 260 0 R 261 0 R 262 0 R 263 0 R 265 0 R 266 0 R 267 0 R 268 0 R 269 0 R 270 0 R 271 0 R 272 0 R 274 0 R 275 0 R 276 0 R 277 0 R 278 0 R 279 0 R 280 0 R 281 0 R 282 0 R 283 0 R 284 0 R 285 0 R 286 0 R 287 0 R 288 0 R 289 0 R 290 0 R 291 0 R 292 0 R 293 0 R 294 0 R 295 0 R 296 0 R 297 0 R 298 0 R 299 0 R 300 0 R 301 0 R 302 0 R 303 0 R 304 0 R 305 0 R 306 0 R 307 0 R 308 0 R 309 0 R 310 0 R 311 0 R 312 0 R 313 0 R 315 0 R 316 0 R 317 0 R 318 0 R] /P 36 0 R /S /Document /Type /StructElem >> endobj 38 0 obj << /A << /BBox [237.3662 733.35059 381.07291 751.06195] /O /Layout /Placement /Block >> /ActualText (ұ Phlebotomy Program\r\nApplication Packet\r\n) /K [0 1] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 72 0 R >> endobj 39 0 obj << /A << /BBox [28.85565 679.73364 379.02536 727.23218] /O /Layout /Placement /Block >> /ActualText (We appreciate your interest in the ұ Phlebotomy Program.\r\nPhlebotomy Program applicat\ ions are accepted on a first-qualified, first-served basis, and the program fills fast.\r\nPlease use\ this application to apply for the Spring semester Phlebotomy Program. Exact dates of the program can\ be found on\r\n) /K [2 3 4 5] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 40 0 R >> endobj 40 0 obj (font-size: 6.44048pt; font-family: Helvetica; line-height: 22pt; ) endobj 41 0 obj << /A << /BBox [28.85565 672.4881 124.65779 678.92853] /O /Layout /Placement /Block >> /ActualText (the Phlebotomy Program Website.\r\n) /K [6 7 8] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 42 0 R >> endobj 42 0 obj (font-size: 6.44048pt; font-family: Helvetica; color: rgb\(0,102,204\); ) endobj 43 0 obj << /A << /BBox [86.41744 651.71753 367.83584 659.3656] /O /Layout /Placement /Block >> /ActualText (this application is ONLY for students interested in completing the entire Phlebotomy\r\n) /K [9] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 47 0 R >> endobj 44 0 obj << /A << /BBox [81.98961 651.71753 84.40479 659.3656] /O /Layout /Placement /Block >> /ActualText (-\r\n) /K [10] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 47 0 R >> endobj 45 0 obj << /A << /BBox [28.85565 642.86188 158.0392 659.3656] /O /Layout /Placement /Block >> /ActualText (*** Please note\r\nProgram, including Clinical Externship.\r\n) /K [11 12] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 47 0 R >> endobj 46 0 obj << /A << /BBox [28.85565 607.43921 369.18713 632.79865] /O /Layout /Placement /Block >> /ActualText (If you are interested in ONLY taking PLB109 and PLB111 to fulfill the Medical Lab Science Program\r\n\ Prerequisite requirement, PLEASE just email Candace Byrd \(candace.byrd@phoenixcollege.edu\) for\r\np\ ermission to register.\r\n) /K [13 14 15] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 47 0 R >> endobj 47 0 obj (font-size: 7.64807pt; font-family: Helvetica; line-height: 9pt; ) endobj 48 0 obj << /A << /BBox [28.85565 580.71124 366.12707 594.39728] /O /Layout /Placement /Block >> /ActualText (Follow this checklist carefully to ensure that your application and documentation are complete and in\ order for the selection\r\ncommittee.\r\n) /K [16 17] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 165 0 R >> endobj 49 0 obj << /A << /BBox [28.85565 551.72906 381.06125 565.4151] /O /Layout /Placement /Block >> /ActualText (It is the applicant's responsibility to verify that the application is complete. An adviser may not b\ e able to meet with every student\r\nand is NOT responsible for verifying the completeness of the app\ lication.\r\n) /K [18 19] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 165 0 R >> endobj 50 0 obj << /A << /BBox [28.85565 522.74689 383.94507 536.43292] /O /Layout /Placement /Block >> /ActualText (The following items must be submitted with this packet for the application to be processed and the ap\ plicant to be considered for\r\nadmission to the program\r\n) /K [20 21] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 165 0 R >> endobj 51 0 obj << /A << /BBox [30.46577 514.37427 172.90704 520.41223] /O /Layout /Placement /Block >> /ActualText (ұ Phlebotomy Program Online Application\r\n) /K [22] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 62 0 R >> endobj 52 0 obj << /A << /BBox [30.46577 500.52725 301.70013 511.39557] /O /Layout /Placement /Block >> /ActualText (Completed and signed Health and Safety Documentation Form with copies of actual immunization records \ or laboratory titer\r\nresults as supporting documentation of: \(all require upload\)\r\n) /K [23 24 25 26] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 53 0 obj << /A << /BBox [41.73661 489.65894 236.02174 494.48932] /O /Layout /Placement /Block >> /ActualText (\200\tProof of 2 MMR vaccinations or positive titer results for measles, mumps, AND rubella\r\n) /K [27 28 29 30] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 54 0 obj << /A << /BBox [41.73661 483.621 272.60367 488.45135] /O /Layout /Placement /Block >> /ActualText (\200\tProof of 2 Varicella vaccinations or positive Varicella titer result \(history of chickenpox is\ NOT sufficient\)\r\n) /K [31 32 33 34] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 55 0 obj << /A << /BBox [41.73661 471.5451 294.55603 482.41342] /O /Layout /Placement /Block >> /ActualText (\200\tProof of one-time Tetanus \(Tdap\) vaccination and Td booster if 10 years or more since Tdap va\ ccination, must be\r\ncompleted after June 2015\r\n) /K [35 36 37 38 39] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 56 0 obj << /A << /BBox [41.73661 453.43124 306.10219 470.33749] /O /Layout /Placement /Block >> /ActualText (\200\tProof of Two-Step TB Skin Test consisting of an initial TB skin test result and a boosted TB sk\ in test result 1-3 weeks\r\nfollowing the first test within the last 6 months or negative chest x-ray\ within the last year, \(Quantiferon/T-spot test within\r\nthe last 6 months is also acceptable\)\r\n\ ) /K [40 41 42 43 44 45] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 57 0 obj << /A << /BBox [41.73661 441.35535 298.63285 452.22366] /O /Layout /Placement /Block >> /ActualText (\200\tProof of 3 Hepatitis B vaccinations or positive titer result for Hepatitis B or Hepatitis B Vac\ cination Declination Form\r\n\(waiver optional, can be found on the ұ Phlebotomy Progra\ m website\)\r\n) /K [46 47 48 49 50] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 58 0 obj << /A << /BBox [41.73661 423.24149 311.59431 440.14777] /O /Layout /Placement /Block >> /ActualText (\200\tHealth Declaration statement signed by M.D.,D.O.,N.P.,P.A. signed after February 2025 \(If you\ have not completed this\r\nform, please complete it before continuing with your application. Forms c\ an be found on the ұ Phlebotomy\r\nProgram website\)\r\n) /K [51 52 53 54 55] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 59 0 obj << /A << /BBox [41.73661 411.16559 302.56638 422.03391] /O /Layout /Placement /Block >> /ActualText (\200\tPhotocopy of front and back of current CPR card \(BLS level for the Health Care Provider\), thr\ ough an American Heart\r\nAssociation approved hands-on training program, dates must be valid through\ January 2026.\r\n) /K [56 57 58 59 60] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 60 0 obj << /A << /BBox [41.73661 405.12766 300.18018 409.95801] /O /Layout /Placement /Block >> /ActualText (\200\tPhotocopy of current Level 1 Fingerprint Clearance Card, front and back, dates must be valid th\ rough January 2026.\r\n) /K [61 62 63 64] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 61 0 obj << /A << /BBox [32.07589 389.59 241.43575 395.62793] /O /Layout /Placement /Block >> /ActualText (Phlebotomy Program and Clinical Planning Form \(this form is within this application\)\r\n) /K [65] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 62 0 R >> endobj 62 0 obj (font-size: 6.03795pt; font-family: Calibri; line-height: 7pt; ) endobj 63 0 obj << /A << /BBox [32.07589 373.89133 301.00014 386.77228] /O /Layout /Placement /Block >> /ActualText (Initialed "Essential Abilities Requirements for Promotion and Retention" statements \(this form is wi\ thin this\r\napplication\)\r\n) /K [66 67] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 62 0 R >> endobj 64 0 obj << /A << /BBox [32.07589 347.32434 293.69421 371.07361] /O /Layout /Placement /Block >> /ActualText (Additional Information and Requirements for Acceptance into the Phlebotomy Program\r\nInformation for\ If you are Accepted Conditionally into the Phlebotomy Program\r\nAcknowledgement of Criminal Backgro\ und Check Requirements form \(this form is within this application\)\r\n) /K [68 69 70] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 65 0 R >> endobj 65 0 obj (font-size: 6.03795pt; font-family: Calibri; line-height: 9pt; ) endobj 66 0 obj << /A << /BBox [39.72396 297.33011 346.02172 318.26169] /O /Layout /Placement /Block >> /ActualText (I have reviewed the information above and have provided proof of all required documentation within th\ is\r\napplication. I understand that failure to submit the required documentation may adversely impac\ t my application\r\nand admission to the program.\r\n) /K [71 72 73] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 165 0 R >> endobj 67 0 obj << /A << /BBox [28.85565 286.22028 345.60489 291.85571] /O /Layout /Placement /Block >> /ActualText (Applications will be accepted throughout the year. Students are accepted on a first-qualified, first-\ served basis, and the program fills fast.\r\n) /K [74 75] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 68 0 obj << /A << /BBox [28.85565 267.3819 387.97842 279.05524] /O /Layout /Placement /Block >> /ActualText (NO PARTIAL PROGRAM APPLICATION WILL BE ACCEPTED. THE COLLEGE DOES NOT GUARANTEE ALL APPLICANTS TO BE \ ACCEPTED INTO\r\nTHE PHLEBOTOMY PROGRAM DUE TO LIMITATIONS OF CLINICAL PLACEMENTS\r\n) /K [76 77] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 264 0 R >> endobj 69 0 obj << /A << /BBox [28.85565 254.82295 363.10931 260.45837] /O /Layout /Placement /Block >> /ActualText (The college reserves the right to change the date/times of the program or cancel the program due to t\ he current public health crisis.\r\n) /K [78] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 70 0 obj << /A << /BBox [28.45312 313.10928 38.65162 318.26169] /O /Layout /Placement /Block >> /ActualText (gfedc *\r\n) /K [79 80 81 82 83 84 85] /P 37 0 R /Pg 333 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 71 0 obj << /A << /BBox [113.78948 753.07458 303.59829 761.12518] /O /Layout /Placement /Block >> /ActualText (ұ Phlebotomy Program Information\r\n) /K [0] /P 37 0 R /Pg 1 0 R /S /P /Type /StructElem /XXStyle 72 0 R >> endobj 72 0 obj (font-size: 8.0506pt; font-family: Helvetica; font-weight: 700; line-height: 10pt; ) endobj 73 0 obj << /A << /BBox [28.85565 740.51563 111.30668 746.95612] /O /Layout /Placement /Block >> /ActualText (PROGRAM INFORMATION:\r\n) /K [1] /P 37 0 R /Pg 1 0 R /S /P /Type /StructElem /XXStyle 199 0 R >> endobj 74 0 obj << /A << /BBox [28.85565 714.91473 374.25055 733.43109] /O /Layout /Placement /Block >> /ActualText (The Phlebotomy Certificate Program is designed to prepare students to obtain blood specimens by skin \ puncture or venipuncture using\r\nproper techniques on adults, children and infants. Students in the \ Phlebotomy Program will be in contact with potentially infectious blood,\r\ntissues, and body fluids.\ The program is 7 credits.\r\n) /K [2 3 4] /P 37 0 R /Pg 1 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 75 0 obj << /A << /BBox [28.85565 695.43231 121.48263 701.87274] /O /Layout /Placement /Block >> /ActualText (OCCUPATION INFORMATION:\r\n) /K [5] /P 37 0 R /Pg 1 0 R /S /P /Type /StructElem /XXStyle 199 0 R >> endobj 76 0 obj << /A << /BBox [28.85565 669.83136 380.38186 688.34778] /O /Layout /Placement /Block >> /ActualText (Phlebotomists may find employment in reference laboratories, hospitals, insurance companies, outreach\ services, patient service centers,\r\nresearch facilities, donor centers and physicians' offices. Th\ e career opportunities are varied and many. The salaries range from $14.00 to\r\n$15.00 per hour.\r\n\ ) /K [6 7 8] /P 37 0 R /Pg 1 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 77 0 obj << /A << /BBox [28.85565 650.34894 195.98611 656.78943] /O /Layout /Placement /Block >> /ActualText (COST ESTIMATE FOR THE PHLEBOTOMY PROGRAM:\r\n) /K [9] /P 37 0 R /Pg 1 0 R /S /P /Type /StructElem /XXStyle 199 0 R >> endobj 78 0 obj << /A << /BBox [28.85565 631.18848 375.1691 643.2644] /O /Layout /Placement /Block >> /ActualText (The cost of the program is approximately $1400, which includes tuition for all courses, lab/course fe\ es and clinical externship experience.\r\nOptional textbooks for the program are an additional $120.\r\ \n) /K [10 11] /P 37 0 R /Pg 1 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 79 0 obj << /A << /BBox [28.85565 611.70605 106.5214 618.14655] /O /Layout /Placement /Block >> /ActualText (HEALTH DECLARATION:\r\n) /K [12] /P 37 0 R /Pg 1 0 R /S /P /Type /StructElem /XXStyle 199 0 R >> endobj 80 0 obj << /A << /BBox [28.85565 586.10516 374.56049 604.62152] /O /Layout /Placement /Block >> /ActualText (All students must provide documentation of compliance with all health and safety requirements require\ d to protect patient\r\nsafety. Only students in compliance are permitted to enroll in Phlebotomy cou\ rses if accepted into the program. Students will meet these\r\nrequirements by providing the required\ documentation described in the application packet during the application process.\r\n) /K [13 14 15 16] /P 37 0 R /Pg 1 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 81 0 obj << /A << /BBox [28.85565 553.90271 382.87836 578.85962] /O /Layout /Placement /Block >> /ActualText (Students must be able to fully participate in program activities whether in the classroom, laboratory\ , or clinical settings. Students who have a\r\nchronic illness or condition must be maintained on cur\ rent treatment and be able to implement direct patient care. This is inclusive of\r\nexternships whic\ h may have additional requirements and or restrictions for participation. Should a student become una\ ble to participate\r\npartially or fully in the programs' activities he/she may be withdrawn from the\ program.\r\n) /K [17 18 19 20] /P 37 0 R /Pg 1 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 82 0 obj << /A << /BBox [28.85565 528.14081 377.32748 546.65723] /O /Layout /Placement /Block >> /ActualText (Invasive procedures are innate in the Phlebotomy program and include but are not limited to venipunct\ ure and skin punctures. The health\r\ncare community expects a student who has completed the Phleboto\ my Program to have performed successful venipuncture and skin\r\npunctures prior to clinical experien\ ce.\r\n) /K [21 22 23] /P 37 0 R /Pg 1 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 83 0 obj << /A << /BBox [28.85565 492.55716 387.89136 520.73425] /O /Layout /Placement /Block >> /ActualText (Therefore, students must practice on one another during laboratory sessions in this program, with han\ d and arm venipunctures as\r\nwell as skin punctures. Students will perform approximately 40 venipunc\ tures on each other throughout the duration of the program.\r\nRefusing to fully participate in the v\ enipuncture and skin puncture learning process will result in failure of, or withdrawal from, the\r\n\ program.\r\n) /K [24 25 26 27] /P 37 0 R /Pg 1 0 R /S /P /Type /StructElem /XXStyle 165 0 R >> endobj 84 0 obj << /A << /BBox [28.85565 466.95627 388.17566 485.47263] /O /Layout /Placement /Block >> /ActualText (The performance of exposure prone procedures presents a recognized risk of percutaneous injury, and-i\ f such injury occurs-blood is likely\r\nto contact the patient's body cavity, subcutaneous tissues, a\ nd /or mucous membranes. This can pose a material risk to patients and students\r\nin the program sho\ uld the student have a communicable chronic illness.\r\n) /K [28 29 30] /P 37 0 R /Pg 1 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 85 0 obj << /A << /BBox [28.85565 441.19434 339.20065 459.71072] /O /Layout /Placement /Block >> /ActualText (Please refer to the following website for the CDC's MMWR for recommendations for Preventing Transmiss\ ion of Human\r\nImmunodeficiency Virus and Hepatitis B Virus to Patients During Exposure Prone Invasi\ ve Procedures.\r\nhttp://www.cdc.gov/mmwr/preview/mmwrhtml/00014845.htm\r\n) /K [31 32 33 34] /P 37 0 R /Pg 1 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 86 0 obj << /A << /BBox [28.85565 421.9534 357.77417 427.18628] /O /Layout /Placement /Block >> /ActualText (The Phlebotomy Program Director will review on a case by case basis the ability for a student to full\ y participate in and complete the program.\r\n) /K [35] /P 37 0 R /Pg 1 0 R /S /P /Type /StructElem /XXStyle 147 0 R >> endobj 87 0 obj << /A << /BBox [39.72396 378.23865 261.48516 391.92465] /O /Layout /Placement /Block >> /ActualText (I understand the above information and agree to fully participate in the program's\r\nactivities.\r\n\ ) /K [36 37] /P 37 0 R /Pg 1 0 R /S /P /Type /StructElem /XXStyle 165 0 R >> endobj 88 0 obj << /A << /BBox [28.45312 386.77228 38.65162 391.92465] /O /Layout /Placement /Block >> /ActualText (gfedc *\r\n) /K [38 39 40 41 42 43 44] /P 37 0 R /Pg 1 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 89 0 obj << /A << /BBox [136.73369 743.41388 280.4404 761.12518] /O /Layout /Placement /Block >> /ActualText (ұ Phlebotomy Program\r\nApplication\r\n) /K [0 1] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 72 0 R >> endobj 90 0 obj << /A << /BBox [28.85565 723.60938 385.89368 737.29541] /O /Layout /Placement /Block >> /ActualText (Phlebotomy Program applications must be submitted online. Students are accepted on a first-qualified,\ first-served basis, and the\r\nprogram fills fast.\r\n) /K [2 3 4 5] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 165 0 R >> endobj 91 0 obj << /A << /BBox [28.85565 706.62262 53.42769 711.453] /O /Layout /Placement /Block >> /ActualText (Last Name\r\n) /K [6] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 92 0 obj << /A << /BBox [110.97177 706.62262 135.53899 711.453] /O /Layout /Placement /Block >> /ActualText (First Name\r\n) /K [7] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 93 0 obj << /A << /BBox [184.23222 706.62262 213.61047 711.453] /O /Layout /Placement /Block >> /ActualText (Middle Name\r\n) /K [8] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 94 0 obj << /A << /BBox [257.49268 706.62262 376.18912 711.453] /O /Layout /Placement /Block >> /ActualText (Former name\(s\) \(Maiden\) that may identify transcripts:\r\n) /K [9] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 95 0 obj << /A << /BBox [28.85565 687.30121 101.29092 692.13153] /O /Layout /Placement /Block >> /ActualText (Student ID Number \(starts with a 3\)\r\n) /K [10 11] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 96 0 obj << /A << /BBox [110.97177 687.30121 170.17749 692.13153] /O /Layout /Placement /Block >> /ActualText (Are you over the age of 18?\r\n) /K [12] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 97 0 obj << /A << /BBox [184.23222 687.30121 218.06891 692.13153] /O /Layout /Placement /Block >> /ActualText (Phone Number\r\n) /K [13] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 98 0 obj << /A << /BBox [28.85565 665.56458 64.296 670.3949] /O /Layout /Placement /Block >> /ActualText (Mailing Address\r\n) /K [14] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 99 0 obj << /A << /BBox [178.19427 665.56458 186.24489 670.3949] /O /Layout /Placement /Block >> /ActualText (City\r\n) /K [15] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 100 0 obj << /A << /BBox [280.03436 665.56458 291.31326 670.3949] /O /Layout /Placement /Block >> /ActualText (State\r\n) /K [16] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 101 0 obj << /A << /BBox [307.4064 665.56458 314.24619 670.3949] /O /Layout /Placement /Block >> /ActualText (Zip\r\n) /K [17] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 102 0 obj << /A << /BBox [28.85565 643.42542 41.72856 648.2558] /O /Layout /Placement /Block >> /ActualText (Email\r\n) /K [18] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 103 0 obj << /A << /BBox [28.85565 617.18048 376.08407 628.85382] /O /Layout /Placement /Block >> /ActualText (Please provide an email address that you check regularly. Correspondence regarding the program will b\ e sent to the email address you\r\nprovide above.\r\n) /K [19 20] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 264 0 R >> endobj 104 0 obj << /A << /BBox [28.85565 566.54218 170.26927 584.65601] /O /Layout /Placement /Block >> /ActualText (What is your current occupation:\r\nHave you attended any other Phlebotomy Courses or Programs?\r\n) /K [21 22] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 105 0 R >> endobj 105 0 obj (font-size: 4.83036pt; font-family: Helvetica; line-height: 13pt; ) endobj 106 0 obj << /A << /BBox [28.85565 518.64111 146.10379 542.30988] /O /Layout /Placement /Block >> /ActualText (Please upload a copy of your high school diploma:\r\nGED\r\n) /K [23 24] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 107 0 R >> endobj 107 0 obj (font-size: 5.23289pt; font-family: Helvetica; line-height: 18pt; ) endobj 108 0 obj << /A << /BBox [77.15925 518.64111 123.5452 523.4715] /O /Layout /Placement /Block >> /ActualText (High School Diploma\r\n) /K [25] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 109 0 obj << /A << /BBox [156.45766 518.64111 179.48116 523.4715] /O /Layout /Placement /Block >> /ActualText (AA Degree\r\n) /K [26] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 110 0 obj << /A << /BBox [207.17644 518.64111 219.25717 523.4715] /O /Layout /Placement /Block >> /ActualText (Other\r\n) /K [27] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 111 0 obj (font-size: 4.83036pt; font-family: Helvetica; line-height: 6pt; ) endobj 112 0 obj << /A << /BBox [27.24553 589.16437 155.2565 595.60486] /O /Layout /Placement /Block >> /ActualText (Health Care/Work/Educational Experience\r\n) /K [28] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 199 0 R >> endobj 113 0 obj << /A << /BBox [27.24553 552.93665 58.66863 559.37714] /O /Layout /Placement /Block >> /ActualText (Education\r\n) /K [29] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 199 0 R >> endobj 114 0 obj << /A << /BBox [27.24553 527.89929 139.08286 532.72968] /O /Layout /Placement /Block >> /ActualText (Check each level of education you have completed.\r\n) /K [30] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 115 0 obj << /A << /BBox [28.45312 698.65253 30.06324 703.08038] /O /Layout /Placement /Block >> /ActualText (*\r\n) /K [31] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 117 0 R >> endobj 116 0 obj << /A << /BBox [110.56924 698.65253 112.17936 703.08038] /O /Layout /Placement /Block >> /ActualText (*\r\n) /K [32] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 117 0 R >> endobj 117 0 obj (font-size: 4.42783pt; font-family: Helvetica; color: rgb\(179,0,0\); ) endobj 118 0 obj << /A << /BBox [28.45312 679.33105 30.06324 683.75891] /O /Layout /Placement /Block >> /ActualText (*\r\n) /K [33] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 117 0 R >> endobj 119 0 obj << /A << /BBox [110.56924 679.33105 112.17936 683.75891] /O /Layout /Placement /Block >> /ActualText (*\r\n) /K [34] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 117 0 R >> endobj 120 0 obj << /A << /BBox [183.8297 679.33105 185.43982 683.75891] /O /Layout /Placement /Block >> /ActualText (*\r\n) /K [35] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 117 0 R >> endobj 121 0 obj << /A << /BBox [28.45312 657.59448 30.06324 662.02228] /O /Layout /Placement /Block >> /ActualText (*\r\n) /K [36] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 117 0 R >> endobj 122 0 obj << /A << /BBox [177.79175 657.59448 179.40187 662.02228] /O /Layout /Placement /Block >> /ActualText (*\r\n) /K [37] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 117 0 R >> endobj 123 0 obj << /A << /BBox [294.52545 655.58179 298.55075 662.02228] /O /Layout /Placement /Block >> /ActualText (\000\r\000\n) /K [38] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 124 0 R >> endobj 124 0 obj (font-size: 6.44048pt; font-family: Segoe UI Symbol; ) endobj 125 0 obj << /A << /BBox [279.63184 657.59448 281.24197 662.02228] /O /Layout /Placement /Block >> /ActualText (*\r\n) /K [39] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 117 0 R >> endobj 126 0 obj << /A << /BBox [307.00388 657.59448 308.61401 662.02228] /O /Layout /Placement /Block >> /ActualText (*\r\n) /K [40] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 117 0 R >> endobj 127 0 obj << /A << /BBox [28.45312 635.45532 30.06324 639.88312] /O /Layout /Placement /Block >> /ActualText (*\r\n) /K [41] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 117 0 R >> endobj 128 0 obj << /A << /BBox [198.72331 565.01257 202.74861 571.45306] /O /Layout /Placement /Block >> /ActualText (\000\r\000\n) /K [42] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 124 0 R >> endobj 129 0 obj << /A << /BBox [32.07589 518.3996 36.10119 522.42487] /O /Layout /Placement /Block >> /ActualText (gfedc\r\n) /K [43 44 45 46 47] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 130 0 obj << /A << /BBox [67.49853 518.3996 71.52383 522.42487] /O /Layout /Placement /Block >> /ActualText (gfedc\r\n) /K [48 49 50 51 52] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 131 0 obj << /A << /BBox [146.79694 518.3996 150.82224 522.42487] /O /Layout /Placement /Block >> /ActualText (gfedc\r\n) /K [53 54 55 56 57] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 132 0 obj << /A << /BBox [197.51572 518.3996 201.54102 522.42487] /O /Layout /Placement /Block >> /ActualText (gfedc\r\n) /K [58 59 60 61 62] /P 37 0 R /Pg 3 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 133 0 obj << /A << /BBox [28.85565 753.07458 179.34552 761.12518] /O /Layout /Placement /Block >> /ActualText (Health and Safety Documentation Proof\r\n) /K [0] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 72 0 R >> endobj 134 0 obj << /A << /BBox [28.85565 724.65594 375.76486 740.35461] /O /Layout /Placement /Block >> /ActualText (You must upload PROOF of your immunizations in the form of Immunization Records or Laboratory\r\nTite\ r Results.\r\n) /K [1 2] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 176 0 R >> endobj 135 0 obj << /A << /BBox [28.85565 707.74969 228.1225 714.99524] /O /Layout /Placement /Block >> /ActualText (The Health and Safety Document is NOT considered PROOF.\r\n) /K [3] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 137 0 R >> endobj 136 0 obj << /A << /BBox [28.85565 682.39032 385.91586 698.08899] /O /Layout /Placement /Block >> /ActualText (Applications submitted without medical record proof of immunizations, CPR card, fingerprint clearance\ card, and\r\nphysician signature will not be accepted.\r\n) /K [4 5] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 137 0 R >> endobj 137 0 obj (font-size: 7.24554pt; font-family: Helvetica; line-height: 8pt; ) endobj 138 0 obj << /A << /BBox [322.30002 617.58301 381.09677 642.13733] /O /Layout /Placement /Block >> /ActualText (Upload Files Containing\r\nRequired Documentation:\r\nImmunization Records or\r\nLaboratory Titer Res\ ults\r\n) /K [6 7 8 9] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 147 0 R >> endobj 139 0 obj << /A << /BBox [30.8683 599.06659 72.75758 610.73999] /O /Layout /Placement /Block >> /ActualText (Measles, Mumps,\r\nRubella\r\n) /K [10 11] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 147 0 R >> endobj 140 0 obj << /A << /BBox [86.81997 586.18567 313.69192 610.73999] /O /Layout /Placement /Block >> /ActualText (Proof of immunity through serologic testing \(positive IgG titer\)\r\nOR documentation of two \(2\) d\ oses of MMR vaccination on separate dates at least 28 days apart.\r\nIf a titer shows negative, equiv\ ocal, or non-reactive you will be required to repeat the MMR series\r\nwith two \(2\) additional immu\ nizations and provide appropriate documentation.\r\n) /K [12 13 14 15] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 147 0 R >> endobj 141 0 obj << /A << /BBox [30.8683 574.10974 50.97829 579.34265] /O /Layout /Placement /Block >> /ActualText (Varicella\r\n) /K [16] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 147 0 R >> endobj 142 0 obj << /A << /BBox [86.81997 548.34784 301.75301 579.34265] /O /Layout /Placement /Block >> /ActualText (Proof of immunity through serologic testing \(positive IgG titer\)\r\nOR documentation of two \(2\) d\ oses of Varicella vaccination 30 days apart.\r\nIf a titer shows negative, equivocal, or non-reactive\ you will be required to repeat the Varicella\r\nseries with two \(2\) additional immunizations and p\ rovide appropriate documentation.\r\nHistory of chickenpox is NOT sufficient proof of immunity.\r\n) /K [17 18 19 20 21] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 147 0 R >> endobj 143 0 obj << /A << /BBox [30.8683 536.27191 79.9788 541.50482] /O /Layout /Placement /Block >> /ActualText (Tetanus - Td or Tdap\r\n) /K [22] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 147 0 R >> endobj 144 0 obj << /A << /BBox [86.81997 529.75092 310.33521 541.82684] /O /Layout /Placement /Block >> /ActualText (Documentation of a one-time Tdap vaccination and Td booster if 10 years or more since\r\nTdap vaccina\ tion \(or if received Tdap prior to turning 19 years old\).\r\n) /K [23 24 25] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 145 0 obj << /A << /BBox [30.8683 517.75555 60.40273 522.9884] /O /Layout /Placement /Block >> /ActualText (Tuberculosis\r\n) /K [26] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 147 0 R >> endobj 146 0 obj << /A << /BBox [86.81997 472.67218 309.919 522.9884] /O /Layout /Placement /Block >> /ActualText (Two-Step TB Skin Test consisting of an initial TB skin test and a boosted TB skin test 1-3\r\nweeks f\ ollowing the first test within the last 6 months, including date given, date read,\r\nresult, and nam\ e and signature of the healthcare provider.\r\nOR Negative Two-Step TB Skin Test and annual testing w\ ithin the last 6 months.\r\nOR Negative chest X-ray and annual documentation of a TB disease-free sta\ tus by completing a\r\nTuberculosis Screening Questionnaire.\r\nOR Documentation of a negative result\ from an IGRA test \(Quantiferon, T-Spot\) within the last 6\r\nmonths\r\n) /K [27 28 29 30 31 32 33 34] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 147 0 R >> endobj 147 0 obj (font-size: 5.23289pt; font-family: Helvetica; line-height: 6pt; ) endobj 148 0 obj << /A << /BBox [30.8683 460.59628 56.64029 465.82916] /O /Layout /Placement /Block >> /ActualText (Hepatitis B\r\n) /K [35] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 147 0 R >> endobj 149 0 obj << /A << /BBox [86.81997 428.39389 316.70083 465.82916] /O /Layout /Placement /Block >> /ActualText (Proof of immunity through serologic testing \(positive HbsAB titer\)\r\nOR documentation of three \(3\ \) doses of Hepatitis B vaccination \(an initial injection followed by a\r\nsecond injection given 1 \ or 2 months after the first dose and a third injection 4 to 6 months after the\r\nfirst\)\r\nOR signe\ d declination form which can be found at the ұ Phlebotomy Program\r\nwebsite.\r\n) /K [36 37 38 39 40 41 42] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 147 0 R >> endobj 150 0 obj << /A << /BBox [30.8683 409.8775 73.53205 421.55087] /O /Layout /Placement /Block >> /ActualText (Health Declaration\r\nStatement\r\n) /K [43 44] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 147 0 R >> endobj 151 0 obj << /A << /BBox [86.81997 390.55606 313.84125 421.87289] /O /Layout /Placement /Block >> /ActualText (Completion of the Health and Safety Documentation Healthcare Provider Form signed\r\nby a physician \(\ M.D. or D.O., Nurse Practitioner, or Physician's Assistant\) within the last 6\r\nmonths.\r\nThe form\ can be found at the ұ Phlebotomy Program website.\r\nPlease upload a scanned version o\ f the completed form.\r\n) /K [45 46 47 48 49 50 51] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 147 0 R >> endobj 152 0 obj << /A << /BBox [30.8683 378.48016 53.41159 383.71304] /O /Layout /Placement /Block >> /ActualText (CPR card\r\n) /K [52] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 147 0 R >> endobj 153 0 obj << /A << /BBox [86.81997 314.07535 316.7113 383.71304] /O /Layout /Placement /Block >> /ActualText (Healthcare Provider/Basic Life Support \(BLS\) CPR card issued by the American Heart Association.\r\n\ All Health Science Programs require American Heart Association Healthcare Provider CPR\r\ncertificati\ on.\r\nThis certification includes training for adult/Child/Infant CPR, choking, AED, and one- and tw\ o-man\r\nrescuer.\r\nPlease be sure to verify with the trainer that the course you take satisfies the\ se requirements.\r\nCourses that do not have a demonstration component will not be accepted. Examples\ would be\r\ncards received on the internet that do not have an in-person skills review.\r\nA fully o\ nline CPR course will NOT be accepted.\r\nProvide a photocopy of the front and back of the card. The \ card must be valid throughout the\r\nduration of the program.\r\n) /K [53 54 55 56 57 58 59 60 61 62 63] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 147 0 R >> endobj 154 0 obj << /A << /BBox [30.8683 295.55899 73.13841 307.23236] /O /Layout /Placement /Block >> /ActualText (Level 1 Fingerprint\r\nClearance Card\r\n) /K [64 65] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 147 0 R >> endobj 155 0 obj << /A << /BBox [86.81997 289.1185 230.94549 307.23236] /O /Layout /Placement /Block >> /ActualText (Issued by the Arizona Department of Public Safety.\r\nProvide a photocopy of the front and back of th\ e card.\r\nThe card must be valid throughout the duration of the program.\r\n) /K [66 67 68] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 147 0 R >> endobj 156 0 obj << /A << /BBox [30.8683 277.52563 79.96407 282.35599] /O /Layout /Placement /Block >> /ActualText (COVID19 vaccinations\r\n) /K [69] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 157 0 obj << /A << /BBox [86.81997 271.4877 309.19524 282.35599] /O /Layout /Placement /Block >> /ActualText (Provide proof of two-dose vaccination of Pfizer-BioNTech or Moderna vaccine. OR Provide proof of one\r\ \ndose vaccination of Johnson & Johnson's Janssen vaccine\r\n) /K [70 71] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 158 0 obj << /A << /BBox [30.8683 252.89081 65.8554 264.56418] /O /Layout /Placement /Block >> /ActualText (Additional\r\nDocumentation\r\n) /K [72 73] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 147 0 R >> endobj 159 0 obj << /A << /BBox [86.81997 259.33127 292.09054 264.56418] /O /Layout /Placement /Block >> /ActualText (If there is any additional documentation that you would like to upload, please do so here:\r\n) /K [74] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 147 0 R >> endobj 160 0 obj << /A << /BBox [39.72396 650.34894 382.25065 664.4375] /O /Layout /Placement /Block >> /ActualText (I understand that I MUST provide medical record proof of immunizations, TB status, doctor's clearance\ , CPR, and fingerprint\r\nclearance card. I understand that the Health Declaration checklist form is \ NOT proof.\r\n) /K [75 76 77 78 79 80] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 161 0 R >> endobj 161 0 obj (font-size: 6.44048pt; font-family: Helvetica; line-height: 8pt; ) endobj 162 0 obj << /A << /BBox [28.45312 659.2851 38.65162 664.4375] /O /Layout /Placement /Block >> /ActualText (gfedc *\r\n) /K [81 82 83 84 85 86 87] /P 37 0 R /Pg 11 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 163 0 obj (font-size: 4.0253pt; font-family: Marlett; font-weight: 500; color: rgb\(255,255,255\); line-height: \ 15pt; ) endobj 164 0 obj << /A << /BBox [129.48814 755.00671 287.22195 761.4472] /O /Layout /Placement /Block >> /ActualText (Phlebotomy Program Course and Clinical Planning Form\r\n) /K [0] /P 37 0 R /Pg 13 0 R /S /P /Type /StructElem /XXStyle 165 0 R >> endobj 165 0 obj (font-size: 6.44048pt; font-family: Helvetica; line-height: 7pt; ) endobj 166 0 obj << /A << /BBox [28.85565 734.47772 385.50662 748.1637] /O /Layout /Placement /Block >> /ActualText (In order to successfully complete the Phlebotomy program, you must indicate that you understand the c\ ourse and clinical schedule\r\nyou will be required to participate in.\r\n) /K [1 2] /P 37 0 R /Pg 13 0 R /S /P /Type /StructElem /XXStyle 165 0 R >> endobj 167 0 obj << /A << /BBox [28.85565 712.74109 386.67062 726.42712] /O /Layout /Placement /Block >> /ActualText (Clinical externship hours must be completed during the dates/times listed, evening/weekend hours are \ not available. However, the\r\nactual start times may vary and are determined by the individual clini\ cal site.\r\n) /K [3 4] /P 37 0 R /Pg 13 0 R /S /P /Type /StructElem /XXStyle 165 0 R >> endobj 168 0 obj << /A << /BBox [28.85565 690.1994 385.63247 704.28796] /O /Layout /Placement /Block >> /ActualText (**If your availability for clinical externship does not fall into the below dates and times, you will\ not be able to be placed\r\nin a clinical externship, and will be removed from the Phlebotomy Progra\ m.**\r\n) /K [5 6] /P 37 0 R /Pg 13 0 R /S /P /Type /StructElem /XXStyle 169 0 R >> endobj 169 0 obj (font-size: 6.44048pt; font-family: Helvetica; font-style: italic; font-weight: 700; line-height: 8pt;\ ) endobj 170 0 obj << /A << /BBox [40.93155 678.12347 134.3075 684.56396] /O /Layout /Placement /Block >> /ActualText (I understand the above statement.\r\n) /K [7] /P 37 0 R /Pg 13 0 R /S /P /Type /StructElem /XXStyle 165 0 R >> endobj 171 0 obj << /A << /BBox [28.85565 634.32825 385.77899 654.05219] /O /Layout /Placement /Block >> /ActualText (Check the box next to the Program Dates and corresponding Clinical Externship Dates for the\r\nphlebo\ tomy program schedule you are applying for.\r\n) /K [8 9] /P 37 0 R /Pg 13 0 R /S /P /Type /StructElem /XXStyle 172 0 R >> endobj 172 0 obj (font-size: 8.0506pt; font-family: Helvetica; font-weight: 700; line-height: 12pt; ) endobj 173 0 obj << /A << /BBox [28.85565 616.45587 59.44632 621.28625] /O /Layout /Placement /Block >> /ActualText (Fall semester\r\n) /K [10] /P 37 0 R /Pg 13 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 174 0 obj << /A << /BBox [67.90106 607.3587 221.25381 615.4093] /O /Layout /Placement /Block >> /ActualText (Fall 2025 Phlebotomy Program Schedule\r\n) /K [11] /P 37 0 R /Pg 13 0 R /S /P /Type /StructElem /XXStyle 72 0 R >> endobj 175 0 obj << /A << /BBox [67.90106 578.5376 375.53943 594.23627] /O /Layout /Placement /Block >> /ActualText (Orientation for PLB109 and PLB111 is on Tuesday, August 12, 2025 from 5pm-6:30pm in\r\nthe Phoenix C\ ollege HE building.\r\n) /K [12 13] /P 37 0 R /Pg 13 0 R /S /P /Type /StructElem /XXStyle 176 0 R >> endobj 176 0 obj (font-size: 7.24554pt; font-family: Helvetica; font-weight: 700; line-height: 8pt; ) endobj 177 0 obj << /A << /BBox [67.90106 544.72504 383.65445 568.87683] /O /Layout /Placement /Block >> /ActualText (Classes \(PLB109 and PLB111\) run sequentially from August 26, 2025 through November 6,\r\n2025, on T\ uesdays and Thursdays from 5pm-9pm. PLB109 runs from August 26 through\r\nOctober 2 and PLB111 runs f\ rom October 7 through November 6.\r\n) /K [14 15 16 17] /P 37 0 R /Pg 13 0 R /S /P /Type /StructElem /XXStyle 176 0 R >> endobj 178 0 obj << /A << /BBox [67.90106 519.36566 349.57867 535.06433] /O /Layout /Placement /Block >> /ActualText (PLB109 and PLB111 are hybrid courses. The majority of your coursework will be\r\ncompleted online.\r\n\ ) /K [18 19] /P 37 0 R /Pg 13 0 R /S /P /Type /StructElem /XXStyle 176 0 R >> endobj 179 0 obj << /A << /BBox [67.90106 502.45941 387.65399 509.70496] /O /Layout /Placement /Block >> /ActualText (You will participate in lecture and lab in-person on Tuesdays and Thursdays from 5pm-9pm\r\n) /K [20] /P 37 0 R /Pg 13 0 R /S /P /Type /StructElem /XXStyle 176 0 R >> endobj 180 0 obj << /A << /BBox [67.90106 488.04883 378.56244 501.2518] /O /Layout /Placement /Block >> /ActualText (in the ұ HE building. The property address for the ұ HE building is: 3144\ North 7th Avenue,\r\nPhoenix, AZ 85013, located on the corner of 7th Avenue and Flower. Parking is a\ vailable on-site.\r\n) /K [21 22 23 24] /P 37 0 R /Pg 13 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 181 0 obj << /A << /BBox [67.90106 450.53302 382.31323 474.68484] /O /Layout /Placement /Block >> /ActualText (Clinical externship \(PLB122\):\r\nEvery day, 40 hours per week \(140 hours total\), Mondays through \ Fridays between the hours\r\n) /K [25 26 27 28 29 30] /P 37 0 R /Pg 13 0 R /S /P /Type /StructElem /XXStyle 182 0 R >> endobj 182 0 obj (font-size: 7.24554pt; font-family: Helvetica; font-weight: 700; line-height: 17pt; ) endobj 183 0 obj << /A << /BBox [67.90106 434.59283 365.76614 449.32544] /O /Layout /Placement /Block >> /ActualText (of 7am and 5pm from November 10-28, 2025. Each student schedule will vary depending upon the\r\ndays\ hift hours of the clinical site the student is placed in.\r\n) /K [31 32 33 34 35 36 37] /P 37 0 R /Pg 13 0 R /S /P /Type /StructElem /XXStyle 165 0 R >> endobj 184 0 obj << /A << /BBox [28.85565 421.22885 66.32475 432.09717] /O /Layout /Placement /Block >> /ActualText (I understand and\r\nagree\r\n) /K [38 39] /P 37 0 R /Pg 13 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 185 0 obj << /A << /BBox [67.90106 420.10178 360.52948 426.54224] /O /Layout /Placement /Block >> /ActualText (Please note because of public health situations, externship dates may be delayed or completely cancel\ ed.\r\n) /K [40] /P 37 0 R /Pg 13 0 R /S /P /Type /StructElem /XXStyle 165 0 R >> endobj 186 0 obj << /A << /BBox [67.90106 398.36514 376.20227 412.05118] /O /Layout /Placement /Block >> /ActualText (Every effort will be made to place students in clinical externship but externship dates may be delaye\ d indefinitely\r\ndepending on the current public health situation.\r\n) /K [41 42] /P 37 0 R /Pg 13 0 R /S /P /Type /StructElem /XXStyle 165 0 R >> endobj 187 0 obj << /A << /BBox [67.90106 376.62851 384.32205 390.31454] /O /Layout /Placement /Block >> /ActualText (In the event of clinical externship delay or cancelation, virtual clinical externships with completel\ y online coursework,\r\nwill be required to complete the program and obtain a certificate of completi\ on.\r\n) /K [43 44] /P 37 0 R /Pg 13 0 R /S /P /Type /StructElem /XXStyle 165 0 R >> endobj 188 0 obj << /A << /BBox [28.45312 679.41156 38.65162 684.56396] /O /Layout /Placement /Block >> /ActualText (gfedc *\r\n) /K [45 46 47 48 49 50 51] /P 37 0 R /Pg 13 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 189 0 obj << /A << /BBox [28.45312 610.17645 38.65162 615.3288] /O /Layout /Placement /Block >> /ActualText (gfedc *\r\n) /K [52 53 54 55 56 57 58] /P 37 0 R /Pg 13 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 190 0 obj << /A << /BBox [28.45312 414.94937 38.65162 420.10178] /O /Layout /Placement /Block >> /ActualText (gfedc *\r\n) /K [59 60 61 62 63 64 65] /P 37 0 R /Pg 13 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 191 0 obj << /A << /BBox [28.85565 755.00671 284.6651 761.4472] /O /Layout /Placement /Block >> /ActualText (ESSENTIAL SKILLS AND FUNCTIONAL ABILITIES FOR PHLEBOTOMY STUDENTS:\r\n) /K [0] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 199 0 R >> endobj 192 0 obj << /A << /BBox [28.85565 735.84631 385.49402 747.92218] /O /Layout /Placement /Block >> /ActualText (It is essential that Phlebotomy students be able to perform a number of physical activities in the cl\ inical portion of the program. Students will\r\nbe required to stand for several hours at a time and \ perform bending activities as well as possess manual dexterity.\r\n) /K [1 2 3] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 193 0 obj << /A << /BBox [28.85565 703.64392 382.01614 728.60077] /O /Layout /Placement /Block >> /ActualText (The clinical Phlebotomy experience also places students under considerable mental and emotional stres\ s as they undertake responsibilities\r\nand duties impacting patients' lives. Students must be able t\ o demonstrate rational and appropriate behavior under stressful\r\nconditions. Individuals should giv\ e careful consideration to the mental and physical demands of the program prior to submitting an\r\na\ pplication.\r\n) /K [4 5 6 7 8 9] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 194 0 obj << /A << /BBox [28.85565 677.88196 382.19086 696.39838] /O /Layout /Placement /Block >> /ActualText (Individuals enrolled in the phlebotomy program must be able to perform essential skills. If a student\ believes that he or she cannot meet one\r\nor more of the standards without accommodations, the phle\ botomy program director must determine, on an individual basis, whether a\r\nreasonable accommodation\ can be made.\r\n) /K [10 11 12] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 195 0 obj << /A << /BBox [28.85565 652.12006 385.53265 670.63641] /O /Layout /Placement /Block >> /ActualText (Essential skills and abilities are performance requirements that refer to those physical, cognitive a\ nd behavioral abilities required for\r\nsatisfactory completion of all aspects of a Phlebotomy progra\ m curriculum, and the development of personal attributes required by the faculty\r\nof all students u\ pon completion of the certificate program.\r\n) /K [13 14 15] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 196 0 obj << /A << /BBox [28.85565 626.35815 363.1882 644.87451] /O /Layout /Placement /Block >> /ActualText (The essential abilities required by the curriculum are in the following areas: motor, sensory, commun\ ication, intellectual \(conceptual,\r\nintegrative, and quantitative abilities for problem solving an\ d diagnosis\) and the behavioral and social aspects of the performance of\r\na phlebotomist.\r\n) /K [16 17 18] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 197 0 obj << /A << /BBox [28.85565 613.47717 368.65457 619.11261] /O /Layout /Placement /Block >> /ActualText (These are attributes each phlebotomist must possess and the use of a third party for the fulfillment \ of these attributes is not adequate.\r\n) /K [19] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 198 0 obj << /A << /BBox [28.85565 600.03265 365.32565 606.47314] /O /Layout /Placement /Block >> /ActualText (**By checking each box, you are indicating that you understand and will abide by each of these requir\ ements**\r\n) /K [20] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 199 0 R >> endobj 199 0 obj (font-size: 6.44048pt; font-family: Helvetica; font-weight: 700; ) endobj 200 0 obj << /A << /BBox [39.72396 583.0459 66.70152 587.87628] /O /Layout /Placement /Block >> /ActualText (Motor Skills\r\n) /K [21] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 273 0 R >> endobj 201 0 obj << /A << /BBox [39.72396 563.56348 383.2817 582.07983] /O /Layout /Placement /Block >> /ActualText (Students must possess physical dexterity to master technical and procedural aspects of patient care i\ ncluding, but not limited to: lifting,\r\nsitting, and bending for long periods of time; adequate phy\ sical stamina and energy to carry out taxing duties over long hours; providing\r\ncare in confined sp\ aces; and fine motor skills sufficient to handle small equipment safely.\r\n) /K [22 23 24] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 202 0 obj << /A << /BBox [39.72396 549.2334 77.96659 554.06372] /O /Layout /Placement /Block >> /ActualText (Sensory Abilities\r\n) /K [25] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 273 0 R >> endobj 203 0 obj << /A << /BBox [39.72396 536.19141 367.85757 548.26733] /O /Layout /Placement /Block >> /ActualText (Students must be able to gather information with all senses, especially sight, hearing and manual dex\ terity, in order to perform the\r\nPhlebotomy process of care.\r\n) /K [26 27] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 204 0 obj (font-size: 5.63542pt; font-family: Helvetica; line-height: 6pt; ) endobj 205 0 obj << /A << /BBox [39.72396 521.86133 89.22549 526.69171] /O /Layout /Placement /Block >> /ActualText (Communication Skills\r\n) /K [28] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 273 0 R >> endobj 206 0 obj << /A << /BBox [39.72396 495.93842 384.46514 520.89526] /O /Layout /Placement /Block >> /ActualText (Students must be able to communicate effectively in English with accuracy, clarity and efficiency wit\ h patients, their families and other\r\nmembers of the health care team \(including spoken and non-ve\ rbal communication, such as interpretation of facial expressions, affect\r\nand body language\) and w\ ork cooperatively with supervisors, other students, and all other health care team members. Students \ must be\r\nable to accurately identify patients.\r\n) /K [29 30 31 32] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 207 0 obj << /A << /BBox [39.72396 470.17648 377.60683 488.69287] /O /Layout /Placement /Block >> /ActualText (Students must be able to communicate effectively with patients, including gathering information appro\ priately, explaining medical\r\ninformation in a patient-centered manner, listening effectively, reco\ gnizing, acknowledging and responding to emotions, and exhibiting\r\nsensitivity to social and cultur\ al differences\r\n) /K [33 34 35] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 208 0 obj << /A << /BBox [39.72396 455.84644 84.00443 460.67679] /O /Layout /Placement /Block >> /ActualText (Intellectual Abilities\r\n) /K [36] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 273 0 R >> endobj 209 0 obj << /A << /BBox [39.72396 442.80444 363.87331 454.88037] /O /Layout /Placement /Block >> /ActualText (Students must be able to comprehend and learn factual knowledge from readings and didactic presentati\ ons, gather information\r\nindependently, analyze and synthesize learned material and apply informati\ on to clinical situations.\r\n) /K [37 38] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 210 0 obj << /A << /BBox [39.72396 417.04254 387.497 435.55893] /O /Layout /Placement /Block >> /ActualText (Students must be able to develop sound clinical judgment and exhibit well-integrated knowledge about \ the phlebotomy process of care, to\r\ninclude: assessment, planning, implementation and evaluation of\ phlebotomy services. They must be comfortable with uncertainty and\r\nambiguity in clinical situatio\ ns, and seek the advice of others when appropriate.\r\n) /K [39 40 41] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 211 0 obj << /A << /BBox [39.72396 402.71246 139.61098 407.54282] /O /Layout /Placement /Block >> /ActualText (Behavioral, Social and Professional Abilities\r\n) /K [42] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 273 0 R >> endobj 212 0 obj << /A << /BBox [39.72396 363.90857 385.71621 401.7464] /O /Layout /Placement /Block >> /ActualText (Students must possess the emotional maturity and stability to function effectively under stress that \ is inherent in healthcare professions\r\nand to adapt to circumstances which are unpredictable or tha\ t change rapidly. They must be able to interact productively, cooperatively\r\nand in a collegial man\ ner with individuals of differing personalities and backgrounds, and be an active contributor to the \ process of\r\nproviding health care by demonstrating the ability to engage in teamwork and team build\ ing. They must demonstrate the ability to identify\r\nand set priorities in patient management and in\ all aspects of their professional work. They must be punctual and perform work under\r\nstrict time \ frames.\r\n) /K [43 44 45 46 47 48] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 213 0 obj << /A << /BBox [39.72396 344.58713 357.65182 356.66302] /O /Layout /Placement /Block >> /ActualText (Students must be capable of empathetic response to individuals in many circumstances and be sensitive\ to social and cultural\r\ndifferences.\r\n) /K [49 50] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 214 0 obj << /A << /BBox [39.72396 318.82523 387.88018 337.34158] /O /Layout /Placement /Block >> /ActualText (Students must exhibit an ethic of professionalism, including the ability to place others' needs ahead\ of their own. They must exhibit\r\ncompassion, empathy, altruism, integrity, responsibility and tole\ rance, as well as demonstrate the ability to exercise the requisite judgment\r\nrequired in the pract\ ice of phlebotomy.\r\n) /K [51 52 53] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 215 0 obj << /A << /BBox [28.85565 300.55035 285.04507 306.99084] /O /Layout /Placement /Block >> /ActualText (ESSENTIAL SKILLS AND FUNCTIONAL ABILITIES FOR PHLEBOTOMY STUDENTS:\r\n) /K [54] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 199 0 R >> endobj 216 0 obj << /A << /BBox [39.72396 280.42386 385.9577 294.51239] /O /Layout /Placement /Block >> /ActualText (I have read and have had the opportunity to have all of my questions answered regarding the ESSENTIAL\ SKILLS\r\nAND FUNCTIONAL ABILITIES FOR PHLEBOTOMY STUDENTS in the ұ Phlebotomy Program\ .\r\n) /K [55 56] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 218 0 R >> endobj 217 0 obj << /A << /BBox [39.72396 265.12772 301.09151 271.56821] /O /Layout /Placement /Block >> /ActualText (*Checking this box represents that I understand and will abide by these requirements.\r\n) /K [57] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 218 0 R >> endobj 218 0 obj (font-size: 6.44048pt; font-family: Helvetica; font-weight: 700; color: rgb\(255,0,0\); line-height: 8\ pt; ) endobj 219 0 obj << /A << /BBox [28.45312 582.80438 38.65162 587.95679] /O /Layout /Placement /Block >> /ActualText (gfedc *\r\n) /K [58 59 60 61 62 63 64] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 220 0 obj << /A << /BBox [28.45312 548.99188 38.65162 554.14423] /O /Layout /Placement /Block >> /ActualText (gfedc *\r\n) /K [65 66 67 68 69 70 71] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 221 0 obj << /A << /BBox [28.45312 521.61981 38.65162 526.77222] /O /Layout /Placement /Block >> /ActualText (gfedc *\r\n) /K [72 73 74 75 76 77 78] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 222 0 obj << /A << /BBox [28.45312 455.60492 38.65162 460.75729] /O /Layout /Placement /Block >> /ActualText (gfedc *\r\n) /K [79 80 81 82 83 84 85] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 223 0 obj << /A << /BBox [28.45312 402.47095 38.65162 407.62332] /O /Layout /Placement /Block >> /ActualText (gfedc *\r\n) /K [86 87 88 89 90 91 92] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 224 0 obj << /A << /BBox [28.45312 289.36002 38.65162 294.51239] /O /Layout /Placement /Block >> /ActualText (gfedc *\r\n) /K [93 94 95 96 97 98 99] /P 37 0 R /Pg 18 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 225 0 obj << /A << /BBox [124.65779 743.41388 296.28049 761.12518] /O /Layout /Placement /Block >> /ActualText (Additional Information and Requirements\r\nfor Acceptance into the Phlebotomy Program\r\n) /K [0 1] /P 37 0 R /Pg 20 0 R /S /P /Type /StructElem /XXStyle 72 0 R >> endobj 226 0 obj << /A << /BBox [28.85565 717.3299 380.3706 735.84631] /O /Layout /Placement /Block >> /ActualText (You are responsible for understanding the following information about admission to the Phlebotomy Pro\ gram at ұ, as well as\r\nunderstanding the following information about participating in\ the Phlebotomy Program at ұ, if you are accepted into the\r\nProgram.\r\n) /K [2 3 4] /P 37 0 R /Pg 20 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 227 0 obj << /A << /BBox [39.72396 684.32245 355.3413 696.39838] /O /Layout /Placement /Block >> /ActualText (It is my responsibility to provide all requested information to complete my file. Failure to provide \ all requested information and\r\nrequirements WILL adversely affect my admission into the program.\r\n\ ) /K [5 6] /P 37 0 R /Pg 20 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 228 0 obj << /A << /BBox [39.72396 662.98834 359.32552 675.06427] /O /Layout /Placement /Block >> /ActualText (I understand that admission into the program is conditional until I have successfully completed all r\ equirements and submit any\r\noutstanding documentation to the program director, no later than 2 week\ s prior to the start of the program.\r\n) /K [7 8] /P 37 0 R /Pg 20 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 229 0 obj << /A << /BBox [39.72396 628.77332 387.43499 653.73016] /O /Layout /Placement /Block >> /ActualText (I understand that I will be required to submit to an additional background check AND a urine drug scr\ een after acceptance into the\r\nprogram, and that I am responsible for this expense. Failure to do s\ o, or failure to pass the additional background check or the urine drug\r\nscreen at least 2 weeks pr\ ior to the start of the program, WILL result in removal from the program. Additional information wil\ l be provided\r\nduring the program orientation about this requirement.\r\n) /K [9 10 11 12] /P 37 0 R /Pg 20 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 230 0 obj << /A << /BBox [39.72396 607.43921 372.70403 619.51514] /O /Layout /Placement /Block >> /ActualText (I understand and agree to fully participate in classroom, laboratory, and clinical settings and progr\ am activities, including performing\r\napproximately 40 venipunctures on other students and having ap\ proximately 40 venipunctures performed on myself.\r\n) /K [13 14] /P 37 0 R /Pg 20 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 231 0 obj << /A << /BBox [39.72396 573.22418 385.5584 598.18103] /O /Layout /Placement /Block >> /ActualText (I understand that I will be required to submit all of my health and safety documentation to an Immuni\ zation Compliance Tracker after\r\nacceptance into the program, and that I am responsible for this ex\ pense. Failure to do so, or failure to pass the Immunization Compliance\r\nTracker at least 2 weeks p\ rior to the start of the program WILL result in removal from the program. Additional information will\ be provided\r\nduring the program orientation about this requirement.\r\n) /K [15 16 17 18 19] /P 37 0 R /Pg 20 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 232 0 obj << /A << /BBox [39.72396 557.92804 382.89849 570.00391] /O /Layout /Placement /Block >> /ActualText (The information provided in this application is true, correct, and complete to the best of my knowled\ ge. If any information changes \(such\r\nas name, phone number, or address\), it is my responsibility\ to notify the Phlebotomy Program so the changes can be made in my file.\r\n) /K [20 21] /P 37 0 R /Pg 20 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 233 0 obj << /A << /BBox [39.72396 529.75092 388.2127 554.70782] /O /Layout /Placement /Block >> /ActualText (I understand that the dates for the program courses, including clinical externship, may change withou\ t prior notice, depending upon the\r\ncurrent public health situation in Phoenix. I further understan\ d that I may be accepted into the Phlebotomy Program, but may not complete\r\nthe program with in-per\ son clinical externships if there are extenuating public health circumstances beyond the control of t\ he Phlebotomy\r\nProgram.\r\n) /K [22 23 24 25] /P 37 0 R /Pg 20 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 234 0 obj << /A << /BBox [28.85565 504.23053 376.68783 514.69629] /O /Layout /Placement /Block >> /ActualText (ұ, one of the Maricopa Community Colleges, does not discriminate on a basis of race, co\ lor, gender, national origin, religion, handicap or age in application, admission,\r\nparticipation, \ access and treatment of persons in instructional or employment programs and activities.\r\n) /K [26 27] /P 37 0 R /Pg 20 0 R /S /P /Type /StructElem /XXStyle 235 0 R >> endobj 235 0 obj (font-size: 4.42783pt; font-family: Helvetica; line-height: 6pt; ) endobj 236 0 obj << /A << /BBox [28.85565 485.0701 386.82315 497.146] /O /Layout /Placement /Block >> /ActualText (Application and materials will be reviewed and students notified of their conditional acceptance or n\ onacceptance via email within one week of\r\nsubmitting the application for the ұ Phleb\ otomy Program. Students are accepted on a first-qualified, first-served basis, and the\r\n) /K [28 29 30 31 32 33 34] /P 37 0 R /Pg 20 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 237 0 obj << /A << /BBox [28.85565 479.19318 67.08312 484.02353] /O /Layout /Placement /Block >> /ActualText (program fills fast.\r\n) /K [35] /P 37 0 R /Pg 20 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 238 0 obj << /A << /BBox [27.24553 700.66516 65.11555 707.10565] /O /Layout /Placement /Block >> /ActualText (I certify that:\r\n) /K [36] /P 37 0 R /Pg 20 0 R /S /P /Type /StructElem /XXStyle 199 0 R >> endobj 239 0 obj << /A << /BBox [28.45312 691.08496 38.65162 696.23737] /O /Layout /Placement /Block >> /ActualText (gfedc *\r\n) /K [37 38 39 40 41 42 43] /P 37 0 R /Pg 20 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 240 0 obj << /A << /BBox [28.45312 669.75085 38.65162 674.90326] /O /Layout /Placement /Block >> /ActualText (gfedc *\r\n) /K [44 45 46 47 48 49 50] /P 37 0 R /Pg 20 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 241 0 obj << /A << /BBox [28.45312 648.41681 38.65162 653.56915] /O /Layout /Placement /Block >> /ActualText (gfedc *\r\n) /K [51 52 53 54 55 56 57] /P 37 0 R /Pg 20 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 242 0 obj << /A << /BBox [28.45312 614.20172 38.65162 619.35413] /O /Layout /Placement /Block >> /ActualText (gfedc *\r\n) /K [58 59 60 61 62 63 64] /P 37 0 R /Pg 20 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 243 0 obj << /A << /BBox [28.45312 592.86761 38.65162 598.02002] /O /Layout /Placement /Block >> /ActualText (gfedc *\r\n) /K [65 66 67 68 69 70 71] /P 37 0 R /Pg 20 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 244 0 obj << /A << /BBox [28.45312 549.39441 38.65162 569.8429] /O /Layout /Placement /Block >> /ActualText (gfedc *\r\ngfedc *\r\n) /K [72 73 74 75 76 77 78 79 80 81 82 83 84 85] /P 37 0 R /Pg 20 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 245 0 obj << /A << /BBox [28.85565 755.00671 224.96182 761.4472] /O /Layout /Placement /Block >> /ActualText (If You Are Accepted Conditionally into the Phlebotomy Program:\r\n) /K [0] /P 37 0 R /Pg 22 0 R /S /P /Type /StructElem /XXStyle 199 0 R >> endobj 246 0 obj << /A << /BBox [28.85565 735.44379 383.95474 747.51965] /O /Layout /Placement /Block >> /ActualText (In order for MCCCD students to be able to complete clinical experiences at local hospitals, students \ must meet the standards outilned below.\r\nFailure to complete all of the additional requirements by \ the deadline\(s\) WILL result in removal from the program.\r\n) /K [1 2] /P 37 0 R /Pg 22 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 247 0 obj << /A << /BBox [37.71131 718.13495 342.64792 723.77039] /O /Layout /Placement /Block >> /ActualText (1.\tMCCCD Supplemental Background Check, Immunization Compliance Tracker, and Drug Screen \(cost $150\ \)\r\n) /K [3 4] /P 37 0 R /Pg 22 0 R /S /P /Type /StructElem /XXStyle 251 0 R >> endobj 248 0 obj << /A << /BBox [53.81251 711.69452 114.56636 717.3299] /O /Layout /Placement /Block >> /ActualText (a.\tBackground Check\r\n) /K [5 6] /P 37 0 R /Pg 22 0 R /S /P /Type /StructElem /XXStyle 251 0 R >> endobj 249 0 obj << /A << /BBox [71.52383 685.93256 372.90046 710.88947] /O /Layout /Placement /Block >> /ActualText (i.\tIn addition to the level 1 fingerprint clearance card, each student who is enrolled in the progra\ m must provide\r\ndocumentation that he or she has completed and "passed" a MCCCD-supplemental backgr\ ound check. Students are\r\nrequired to pay the cost of obtaining this supplemental background check \ through the specified vendor. Information\r\nregarding the background check will be handed out if you\ are conditionally accepted into the program.\r\n) /K [7 8 9 10 11] /P 37 0 R /Pg 22 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 250 0 obj << /A << /BBox [53.81251 679.49213 155.68239 685.1275] /O /Layout /Placement /Block >> /ActualText (b.\tImmunization Compliance Tracker\r\n) /K [12 13] /P 37 0 R /Pg 22 0 R /S /P /Type /StructElem /XXStyle 251 0 R >> endobj 251 0 obj (font-size: 5.63542pt; font-family: Helvetica; font-weight: 700; line-height: 6pt; ) endobj 252 0 obj << /A << /BBox [71.52383 660.17065 387.22007 678.68701] /O /Layout /Placement /Block >> /ActualText (i.\tEach student will be required to keep track of their health and safety documentation electronical\ ly through an Immunization\r\nCompliance Tracker via a specific vendor. Students are required to pay \ the cost of the tracker. Information regarding the\r\nimmunization compliance tracker will be handed \ out if you are conditionally accepted into the program.\r\n) /K [14 15 16 17] /P 37 0 R /Pg 22 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 253 0 obj << /A << /BBox [69.51118 653.89117 73.93901 658.72156] /O /Layout /Placement /Block >> /ActualText (iv.\r\n) /K [18] /P 37 0 R /Pg 22 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 254 0 obj << /A << /BBox [77.15925 653.73016 135.48021 659.3656] /O /Layout /Placement /Block >> /ActualText (MCCCD Drug Screen\r\n) /K [19] /P 37 0 R /Pg 22 0 R /S /P /Type /StructElem /XXStyle 251 0 R >> endobj 255 0 obj << /A << /BBox [86.01491 634.40875 378.17036 652.92511] /O /Layout /Placement /Block >> /ActualText (a.\tEach student who is enrolled in the program must provide documentation that he or she has complet\ ed and\r\n"passed" a MCCCD drug screen. Students are required to pay the cost of obtaining this drug \ screen. Information\r\nregarding the drug screen will be handed out if you are conditionally accepted\ into the program.\r\n) /K [20 21 22 23] /P 37 0 R /Pg 22 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 256 0 obj << /A << /BBox [37.71131 612.26959 221.56528 617.90503] /O /Layout /Placement /Block >> /ActualText (2.\tClinical Orientation Modules via myClinicalExchange \(cost $42\)\r\n) /K [24 25] /P 37 0 R /Pg 22 0 R /S /P /Type /StructElem /XXStyle 251 0 R >> endobj 257 0 obj << /A << /BBox [53.81251 592.94812 373.70551 611.46454] /O /Layout /Placement /Block >> /ActualText (a.\tEach student will be required to complete online clinical orientation modules to prepare for clin\ ical externship via\r\nmyClinicalExchange. Students are required to pay the cost of the online clinic\ al orientation. Information regarding the online\r\nclinical orientation will be handed out if you ar\ e conditionally accepted into the program.\r\n) /K [26 27 28 29] /P 37 0 R /Pg 22 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 258 0 obj << /A << /BBox [37.71131 570.80902 87.98891 576.4444] /O /Layout /Placement /Block >> /ActualText (3.\tFlu Vaccination\r\n) /K [30 31] /P 37 0 R /Pg 22 0 R /S /P /Type /StructElem /XXStyle 251 0 R >> endobj 259 0 obj << /A << /BBox [53.81251 557.92804 382.12482 570.00391] /O /Layout /Placement /Block >> /ActualText (a.\tEach student will also be required to obtain a seasonal flu vaccination, prior to the start of cl\ inical externship, depending on the\r\ntime of year. Students are required to pay the cost of their f\ lu vaccination.\r\n) /K [32 33 34 35] /P 37 0 R /Pg 22 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 260 0 obj << /A << /BBox [28.85565 540.21674 356.35809 545.85211] /O /Layout /Placement /Block >> /ActualText (This is for your information only - no action is necessary unless or UNTIL you have been conditionall\ y accepted into the program.\r\n) /K [36] /P 37 0 R /Pg 22 0 R /S /P /Type /StructElem /XXStyle 204 0 R >> endobj 261 0 obj << /A << /BBox [39.72396 516.46747 376.13033 528.54333] /O /Layout /Placement /Block >> /ActualText (I have reviewed the information above and understand the information required from me, if I am condit\ ionally accepted\r\ninto the Phlebotomy Program.\r\n) /K [37 38] /P 37 0 R /Pg 22 0 R /S /P /Type /StructElem /XXStyle 251 0 R >> endobj 262 0 obj << /A << /BBox [28.45312 523.22998 38.65162 528.38232] /O /Layout /Placement /Block >> /ActualText (gfedc *\r\n) /K [39 40 41 42 43 44 45] /P 37 0 R /Pg 22 0 R /S /P /Type /StructElem /XXStyle 163 0 R >> endobj 263 0 obj << /A << /BBox [111.77683 748.88824 303.98338 760.48114] /O /Layout /Placement /Block >> /ActualText (ACKNOWLEDGEMENT OF CRIMINAL BACKGROUND CHECK REQUIREMENTS\r\nMaricopa County Community College Distri\ ct\r\n) /K [0 1] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 264 0 R >> endobj 264 0 obj (font-size: 5.23289pt; font-family: Helvetica; font-weight: 700; line-height: 6pt; ) endobj 265 0 obj << /A << /BBox [28.85565 712.66058 386.76602 741.6427] /O /Layout /Placement /Block >> /ActualText (In applying for admission to a Nursing or Allied Health program \("Program"\) at the Maricopa County \ Community College District , you are required to disclose on the\r\nArizona Department of Public Safe\ ty \(DPS\) form all required information and on the MCCCD authorized background check vendor data col\ lection form any arrests,\r\nconvictions, or charges \(even if the arrest, conviction or charge has b\ een dismissed or expunged\), or participation in first offender, deferred adjudication, pretrial\r\nd\ iversion or other probation program on this form. Additionally, you must disclose anything that is l\ ikely to be discovered in the MCCCD supplemental background\r\ncheck that will be conducted on you.\r\ \n) /K [2 3 4 5 6] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 266 0 obj << /A << /BBox [28.85565 682.47083 378.37085 705.41504] /O /Layout /Placement /Block >> /ActualText (Please complete the DPS form, the MCCCD authorized background check vendor form and any clinical agen\ cy background check form honestly and completely.\r\nThis means that your answers must be truthful, a\ ccurate, and complete. If you know of certain information yet are unsure of whether to disclose it,\ you must\r\ndisclose the information, including any arrest or criminal charge.\r\nAdditionally,\r\n) /K [7 8 9 10] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 267 0 obj << /A << /BBox [28.85565 670.3949 173.72781 675.22528] /O /Layout /Placement /Block >> /ActualText (By signing this acknowledgement, you acknowledge the following:\r\n) /K [11] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 268 0 obj << /A << /BBox [28.85565 652.60309 384.34924 664.27649] /O /Layout /Placement /Block >> /ActualText (1. \tI understand that I must submit to and pay any costs required to obtain a Level-One Fingerprint \ Clearance Card and an MCCCD supplemental criminal\r\nbackground check.\r\n) /K [12 13 14 15] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 147 0 R >> endobj 269 0 obj << /A << /BBox [28.85565 637.30695 377.39493 649.06085] /O /Layout /Placement /Block >> /ActualText (2. \tI understand that failure to obtain a Level-One Fingerprint Clearance Card will result in a deni\ al of admission to a Program or removal from it if I have\r\nbeen conditionally admitted.\r\n) /K [16 17 18] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 147 0 R >> endobj 270 0 obj << /A << /BBox [28.85565 628.93433 32.88417 633.76471] /O /Layout /Placement /Block >> /ActualText (3.\r\n) /K [19] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 271 0 obj << /A << /BBox [36.90625 628.93433 291.88644 633.76471] /O /Layout /Placement /Block >> /ActualText (I understand that I must submit to and pay any costs required to obtain an MCCCD supplemental backgro\ und check.\r\n) /K [20] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 272 0 obj << /A << /BBox [28.85565 608.40527 374.6402 619.27362] /O /Layout /Placement /Block >> /ActualText (4. \tI understand that failure to obtain a "pass" as a result of the MCCCD supplemental criminal back\ ground check will result in a denial of admission to a\r\nProgram or removal from it if I have been c\ onditionally admitted.\r\n) /K [21 22 23] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 273 0 R >> endobj 273 0 obj (font-size: 4.83036pt; font-family: Helvetica; font-weight: 700; line-height: 6pt; ) endobj 274 0 obj << /A << /BBox [28.85565 593.91425 367.52505 604.78253] /O /Layout /Placement /Block >> /ActualText (5. \tI understand that, if my Level-One Fingerprint Clearance Card is revoked or suspended at any tim\ e during the admission process or my enrollment in a\r\nProgram, I am responsible to notify the Progr\ am Director immediately and that I will be removed from the Program.\r\n) /K [24 25 26] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 275 0 obj << /A << /BBox [28.85565 573.38519 384.86124 590.29144] /O /Layout /Placement /Block >> /ActualText (6. \tI understand that a clinical agency may require an additional criminal background check to scre\ en for barrier offenses other than those required by MCCCD, as\r\nwell as a drug screening. I unders\ tand that I am required to pay for any and all criminal background checks and drug screens required b\ y a clinical agency to\r\nwhich I am assigned.\r\n) /K [27 28 29 30] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 276 0 obj << /A << /BBox [28.85565 564.93207 344.2041 569.76239] /O /Layout /Placement /Block >> /ActualText (7. \tI understand that the both the MCCCD supplemental or the clinical agency background check may in\ clude but are not limited to the following:\r\n) /K [31 32] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 277 0 obj << /A << /BBox [48.17709 554.06372 186.30123 558.8941] /O /Layout /Placement /Block >> /ActualText (\200\tNationwide Federal Healthcare Fraud and Abuse Databases\r\n) /K [33 34] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 278 0 obj << /A << /BBox [48.17709 548.02582 110.54187 552.85614] /O /Layout /Placement /Block >> /ActualText (\200\tSocial Security Verification\r\n) /K [35 36] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 279 0 obj << /A << /BBox [48.17709 541.98785 92.87241 546.81824] /O /Layout /Placement /Block >> /ActualText (\200\tResidency History\r\n) /K [37 38] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 280 0 obj << /A << /BBox [48.17709 535.94989 132.30265 540.78027] /O /Layout /Placement /Block >> /ActualText (\200\tArizona Statewide Criminal Records\r\n) /K [39 40] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 281 0 obj << /A << /BBox [48.17709 529.91193 121.08654 534.74231] /O /Layout /Placement /Block >> /ActualText (\200\tNationwide Criminal Database\r\n) /K [41 42] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 282 0 obj << /A << /BBox [48.17709 523.87402 133.49575 528.70435] /O /Layout /Placement /Block >> /ActualText (\200\tNationwide Sexual Offender Registry\r\n) /K [43 44] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 283 0 obj << /A << /BBox [48.17709 517.83606 111.77844 522.66638] /O /Layout /Placement /Block >> /ActualText (\200\tHomeland Security Search\r\n) /K [45 46] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 284 0 obj << /A << /BBox [28.85565 492.47665 386.15094 509.3829] /O /Layout /Placement /Block >> /ActualText (8. \tBy virtue of the MCCCD supplemental background check, I understand that I will be disqualified \ for admission or continued enrollment in a Program based on\r\nmy criminal offenses, the inability to\ verify my Social Security number, or my being listed in an exclusionary database of a Federal Agency\ . The criminal offenses\r\nfor disqualification may include but are not limited to any or all of the\ following:\r\n) /K [47 48 49 50] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 285 0 obj << /A << /BBox [28.85565 273.50034 387.67731 314.55841] /O /Layout /Placement /Block >> /ActualText (9. \tI understand that I must disclose on all background check data collection forms \(DPS, MCCCD bac\ kground check vendor and a clinical agency background\r\ncheck vendor\) all required information incl\ uding any arrests, convictions, or charges \(even if the arrest, conviction or charge has been dismis\ sed or expunged\),\r\nor participation in first offender, deferred adjudication, pretrial diversion o\ r other probation program. That includes any misdemeanors or felonies in Arizona, any\r\nother State\ , or other jurisdiction. I also understand that I must disclose any other relevant information on th\ e forms. I further understand that non-disclosure of\r\nrelevant information on the forms that would\ have resulted in failing the background check will result in denial of admission to or removal from \ a\r\nProgram. Finally, I understand that my failure to disclose other types of information of the fo\ rms will result in a violation of the Student Code of Conduct and may\r\nbe subject to sanctions unde\ r that Code.\r\n) /K [51 52 53 54 55 56 57 58] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 286 0 obj << /A << /BBox [28.85565 240.8954 384.04008 269.87756] /O /Layout /Placement /Block >> /ActualText (10. I understand that, if a clinical agency to which I have been assigned does not accept me based on\ my criminal background check it may result in my inability to\r\ncomplete the Program. I also und\ erstand that MCCCD may, within its discretion, disclose to a clinical agency that I have been rejecte\ d by another clinical\r\nagency. I further understand that MCCCD has no obligation to place me when \ the reason for lack of placement is my criminal background check. Since\r\nclinical agency assignm\ ents are critical requirements for completion of the Program, I acknowledge that my inability to comp\ lete required clinical experience\r\ndue to my criminal background check will result in removal from \ the Program.\r\n) /K [59 60 61 62 63 64] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 287 0 obj << /A << /BBox [28.85565 226.40433 365.21616 237.27264] /O /Layout /Placement /Block >> /ActualText (11. I understand the Programs reserve the authority to determine my eligibility to be admitted to the\ Program or to continue in the Program and admission\r\nrequirements or background check requirements\ can change without notice.\r\n) /K [65 66 67] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 288 0 obj << /A << /BBox [28.85565 205.87531 384.38303 222.78156] /O /Layout /Placement /Block >> /ActualText (12. I understand that I have a duty to immediately report to the Program Director any arrests, convic\ tions, placement on exclusion databases, suspension, removal\r\nof my DPS Fingerprint Clearance Card \ or removal or discipline imposed on any professional license or certificate at any time during my enr\ ollment in a\r\nProgram\r\n) /K [68 69 70 71] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 289 0 obj << /A << /BBox [42.9442 195.00699 153.25031 199.83734] /O /Layout /Placement /Block >> /ActualText (I have read and understand the above information.\r\n) /K [72] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 290 0 obj << /A << /BBox [28.85565 175.60504 191.49629 182.85059] /O /Layout /Placement /Block >> /ActualText (This is the last part of the program application.\r\n) /K [73] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 176 0 R >> endobj 291 0 obj << /A << /BBox [28.85565 150.24565 352.01398 165.94432] /O /Layout /Placement /Block >> /ActualText (Your next step will be to electronically sign the application, which automatically submits the\r\napp\ lication.\r\n) /K [74 75] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 176 0 R >> endobj 292 0 obj << /A << /BBox [28.85565 124.88626 377.10528 140.58493] /O /Layout /Placement /Block >> /ActualText (Do not submit until you are ready and your application is complete. You can not edit the application\r\ \nonce you submit your application. You can only submit your application once.\r\n) /K [76 77] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 176 0 R >> endobj 293 0 obj << /A << /BBox [28.85565 105.3233 377.20511 111.76379] /O /Layout /Placement /Block >> /ActualText (Phlebotomy Program applications must be submitted online as soon as possible. Students are accepted o\ n a first-qualified, first-served\r\n) /K [78 79 80] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 165 0 R >> endobj 294 0 obj << /A << /BBox [28.85565 99.20485 99.73152 104.03521] /O /Layout /Placement /Block >> /ActualText (basis, and the program fills fast.\r\n) /K [81] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 295 0 obj << /A << /BBox [27.24553 453.02872 206.46638 488.04883] /O /Layout /Placement /Block >> /ActualText (Social Security Search-Social Security number does not belong to applicant\r\nAny inclusion on any re\ gistered sex offender database\r\nAny inclusion on any of the Federal exclusion lists or Homeland Sec\ urity watch list\r\nAny conviction of Felony no matter what the age of the conviction\r\nAny warrant \ any state\r\nAny misdemeanor conviction for the following-No matter age of crime\r\n) /K [82 83 84 85 86 87] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 296 0 obj << /A << 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/Layout /Placement /Block >> /ActualText (\200\tassault\r\n) /K [96 97] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 301 0 obj << /A << /BBox [38.51637 411.97067 59.8569 416.80103] /O /Layout /Placement /Block >> /ActualText (\200\trobbery\r\n) /K [98 99] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 302 0 obj << /A << /BBox [38.51637 405.93271 56.22447 410.76306] /O /Layout /Placement /Block >> /ActualText (\200\tarson\r\n) /K [100 101] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 303 0 obj << /A << /BBox [38.51637 399.89474 61.87116 404.72513] /O /Layout /Placement /Block >> /ActualText (\200\textortion\r\n) /K [102 103] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 304 0 obj << /A << /BBox [38.51637 393.85681 61.06449 398.68716] /O /Layout /Placement /Block >> /ActualText (\200\tburglary\r\n) /K [104 105] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 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363.66705 70.72038 368.49741] /O /Layout /Placement /Block >> /ActualText (\200\tillegal drugs\r\n) /K [114 115] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 310 0 obj << /A << /BBox [38.51637 357.62912 77.54085 362.45947] /O /Layout /Placement /Block >> /ActualText (\200\taggravated DUI\r\n) /K [116 117] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 311 0 obj << /A << /BBox [27.24553 340.72284 164.58716 351.59116] /O /Layout /Placement /Block >> /ActualText (Any misdemeanor controlled substance conviction last 7 years\r\nAny other misdemeanor convictions wit\ hin last 3 years\r\n) /K [118 119] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 312 0 obj << /A << /BBox [38.51637 329.85455 68.6868 334.68491] /O /Layout /Placement /Block >> /ActualText (\200\tExceptions:\r\n) /K [120 121] /P 37 0 R /Pg 24 0 R /S /P /Type /StructElem /XXStyle 111 0 R >> endobj 313 0 obj << /A << /BBox [54.61757 323.81659 56.22769 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