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 (update 4/2025)

Clinical Affiliate Site Reporting Form Continued – for programs with more than 25 clinical affiliates (update 5/2025)

Clinical Sufficiency Survey Form (Initial Programs) (update 4/2025)

Outcomes Tracking & Survey Forms

ARC/STSA Outcomes Tracking Tool

The OTT must be maintained on campus and submitted upon request from the ARC/STSA.

Outcomes Tracking Tools Sample

This Graduate Survey Tool is required for use for graduates who completed the program. The survey can be administered on graduation date or after. Students must be considered a graduate at the time of survey completion.

ST Employer Survey Tool

This Employer Survey Tool is required for use for graduates who completed the program. The survey may be administered to employers immediately upon the hire of the graduate.

Curriculum Forms

Non-Core Curriculum Change – Associate Degree

Curriculum changes are not being reported outside of the Annual Report. Curriculum changes will ONLY be reported on the subsequent Annual Report.

Curriculum Attestation Form – CCST-7e (update 4/2025)

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.

Distance Education Application SAMPLE

Separate Instructional Site SAMPLE

To initiate Distance Education or a Separate Instructional Site please contact the ARC/STSA at info@arcstsa.org to set up a virtual meeting, a minimum of 30 days prior to the delivery change.

Please provide three preferred dates and times, including time zone, to discuss the application process; and provide a list of names, titles, and emails for all individuals who will be participating in the call. The ARC/STSA will contact you to confirm the scheduled meeting. Review sample applications prior to your meeting. The application will be sent to your program following the meeting.

PAC & Planning Forms

Program Evaluation Plan (PEP) Form – ST (update 4/2025)

Plan of Action Form (update 4/2025)

Completing a Plan of Action Form

Program Advisory Committee (PAC) Form – ST (update 4/2025)

Site Evaluation (Site Visit) Forms

Required Materials Checklist for Site Visit– ST Initial Evaluation

Required Materials Checklist for Site Visit – ST Continuing Evaluation

Schedule for Site Visit – ST Initial Evaluation

Schedule for Site Visit – ST Continuing Evaluation

Refer to the site visit policies here.

Personnel, Program, & Sponsor Forms

Fair Practices Form – ST (update 4/2025)

Facility Change Submission Requirements-ST (update 4/2025)

Faculty Schedule of Responsibilities Form-ST

Maximum Enrollment Capacity (MEC) Form (update 4/2025)

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

Clinical Forms

Clinical Affiliate Site Reporting Form – SA

Clinical Affiliate Site Reporting Form Continued – for programs with more than 25 clinical affiliates (update 5/2025)

Clinical Sufficiency Survey Form-SA [Needs Assessment Data Form]

Curriculum Forms

Curriculum changes are not being reported outside of the Annual Report. Curriculum changes will ONLY be reported on the subsequent Annual Report.

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

Outcomes Tracking Tool-SA

The OTT must be maintained on campus and submitted upon request from the ARC/STSA.

SA Graduate Survey Tool

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.

SA Employer Survey Tool

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 Evaluation Plan – SA

Plan of Action Form

Program Advisory Committee (PAC) Form – SA

Program, Sponsor & Personnel Forms

> Fair Practices Form – SA

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