Forms
- All program submissions to the ARC/STSA must be created and sent as one seamless PDF file, with all pages upright/facing the same direction, appropriately labeled and bookmarked.
- The ARC/STSA will not accept or process submissions that are not appropriately bookmarked.
- Emailed submissions must be sent to info@arcstsa.org
- For submissions more than 50 pages in length, please contact info@arcstsa.org for submission instructions.
- Submissions not following the guidelines will be returned to the program for correction and re-submission. Please note that the posted document is to be used as a reference and that not all bookmark labels will apply to your submission.
- Bookmarks should follow the section label examples for applicable submission type – Self-Study, Findings letter Response, or program change.
- Bookmarking Guidelines: Instructions and Examples
- Please note, attestation forms do not require the submission of additional supporting documentation unless specifically requested by the ARC/STSA.
Surgical Technology Forms
Clinical Forms
Clinical Affiliate Site Reporting Form – ST
Clinical Sufficiency Survey Form (Initial Programs)
Outcomes Tracking & Survey Forms
ARC/STSA Outcomes Tracking Tool
The Outcomes Tracking Tool (OTT) is required for use for tracking ARC/STSA-established outcomes for all cohorts enrolled on or after August 1, 2014. The OTT must be maintained on campus and submitted upon request from the ARC/STSA.
See instructions for completing this form and a sample of a completed form.
This Graduate Survey Tool is required for use for graduates who completed the program on or after August 1, 2016, and may be administered immediately upon completion of the program.
This Employer Survey Tool is required for use for graduates who completed the program on or after August 1, 2016, and may be administered immediately upon placement.
Curriculum Forms
Non-Core Curriculum Change – Associate Degree
Forms for Core Curriculum for Surgical Technology, 7th edition [CCST-7e]
*Curriculum Attestation Form – CCST-7e
*As all programs are transitioning to the CCST-7e, the ARC/STSA is not requiring submission of the Core Curriculum Change Packet. Please complete and submit only the Curriculum Attestation Form – CCST-7e.
**ST Curriculum Comparison Map-CCST-7e
**Please note evidence of compliance with Standard III.C. Curriculum must be maintained by the program utilizing the Curriculum Comparison Map and be available upon request by the ARC/STSA.
For curriculum changes falling outside of implementation of the CCST-7e, please contact info@arcstsa.org.
PAC & Planning Forms
Program Evaluation Plan (PEP) Form – ST
Completing a Plan of Action Form
Site Evaluation (Site Visit) Forms
Personnel, Program, & Sponsor Forms
Maximum Enrollment Capacity (MEC) Form
Program Personnel Data Form – President
Program Personnel Data Form – Dean
Program Personnel Data Form – Program Director
Program Personnel Data Form – Interim Program Director
Program Personnel Data Form – Clinical Coordinator
Program Personnel Data Form – Faculty/Instructional Staff
Surgical Assisting Forms
Curriculum Forms
Curriculum Change Packet – Core Curriculum for Surgical Assisting, 4th edition (CCSA-4e)
CCSA-4e Curriculum Attestation Form-SA
*SA Curriculum Comparison Map-CCSA-4e
(*Please note evidence of compliance with Standard III.C. Curriculum should be maintained on the Curriculum Comparison Map and be available when requested.)
Outcomes Tracking and Survey Forms
SASA-ARC/STSA Outcomes Tracking Tool-SA
[required for use for tracking ARC/STSA-established outcomes for all cohorts enrolled on or after August 1, 2014 and upon request by the ARC/STSA]
Click here for instructions for completing this form and a sample of a completed form.
This Graduate Survey Tool is used for graduates who completed the program on or after August 1, 2016, and may be administered immediately upon completion of the program.
This Employer Survey Tool is used for graduates who completed the program on or after August 1, 2016, and may be administered immediately upon placement.
Planning & PAC Forms
Program, Sponsor & Personnel Forms
Maximum Enrollment Capacity (MEC) Form
Standard I.A./I.B/I.C. – Sponsoring Attestation Form
SA Program Personnel Data Form-President
SA Program Personnel Data Form – Dean
SA Program Personnel Data Form-Program Director
Program Personnel Data Form – Interim Program Director
SA Program Personnel Data Form-Medical/Surgical Director
SA Program Personnel Data Form-Didactic Faculty
SA Clinical Preceptor Reporting Form
SA Clinical Preceptor Delegate Reporting Form
Site Evaluation (Site Visit) Forms
Required Materials Checklist for Site Visit – SA Initial Evaluation
Required Materials Checklist for Virtual Site Evaluation – SA Continuing Evaluation