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Surgical Technology Application

* Required

First Name: *

Middle Initial: *

Last Name: *

Laker ID: *

Current Address: *

City: *

State: *

Zip Code: *

Phone: *

Personal Email: * (all further correspondence will be via email)

Identify which semester or term you want to begin coursework: *
Fall semester of:

(year)

Review the appropriate Surgical Technology Application Checklist. The checklist contains information needed to ensure your application is complete. This includes: admission requirements, pre- and co-requisites, tuition and fees.

I have reviewed the information in the Application Checklist *

Students applying to the Surgical Technology program at Lake Land College must be able to meet the technical requirements of the program and not pose a risk to the well-being of patients, other students, staff or themselves. Students applying to the program will need, at a minimum, to be capable of performing all Essential Functions required of the Surgical Technology. The student will need to maintain and demonstrate these abilities throughout the duration of the program.

I have reviewed the list of Essential Functions and understand that I need to be able to perform these functions to complete the Surgical Technology program *

Upon acceptance, I understand that I will be required to comply with all requirements of the program and of the clinical facility to which I am assigned. This may include Covid-19 vaccination or approved exemption requests *

To reduce spam, could you please enter the current 4-digit year? (ex. 2025) *