Forms
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- 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
OTT Completion Tips
ST Graduate Survey Tool
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
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
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
The OTT must be maintained on campus and submitted upon request from the ARC/STSA.
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
SA Schedule of Responsibilities Form (update 4/2025)