12/12/2017
Application Period: April 1 – May 31
Directions: Please complete each item carefully typewritten or neatly printed, and submit this Admission Application
Checklist and all required documents to a Health Sciences Counselor during walk-in counseling hours. If the application
deadline falls on a weekend or recognized holiday, applications will be accepted on the following business day. Only
this completed program Admission Application including supplemental documentation submitted to the Health Career
Counseling Center (Kauila 106) by the appropriate deadline will be accepted for processing. Applications must be
submitted in person during walk-in counseling only.
APPLICANT INFORMATION
Name: UH Number/Username Last Name First Name M.I.
Mailing
Address: Street / POB City State Zip Code
Phone: Cell Home Work
UH SYSTEM Email Address:
List other name(s) used on documents: (Notify the KCC Kekaulike Information & Service Center regarding other names used on college documents.)
ADMISSION APPLICATION CHECKLIST FOR OTA PROGRAM
1. Attend a Mandatory OTA Program Information Session.
For more information visit www.kapiolani.hawaii.edu or pick up an Information Session schedule from
Kauila 122 or Kauila 106, Monday – Friday from 8:00 AM to 4:00 PM.
Date Attended: /_______/________ (Month / Day / Year)
2. Complete the online UH System Application if you are not currently enrolled at any UH System
institution during the semester you submit your application. (http://apply.hawaii.edu)
3. Complete prerequisite courses with a “C” grade or higher by the application deadline.
4. Meet minimum prerequisite GPA of 2.75 or higher by the application deadline.
5. Meet minimum KCC cumulative GPA of 2.0 or higher by the application deadline.
6. College transcripts for courses completed within the University of Hawai‘i System. Print out student
copy of unofficial transcripts for all course work WITHIN the UH System and highlight all
prerequisite/qualification courses. UH system transcripts are downloadable from the UH Portal
(myuh.hawaii.edu).
7. College transcripts for courses completed outside of the University of Hawai‘i System. If transferring courses from institutions outside the UH System, please list the institution and when your
transcript was requested:
• Institution: Transcript Request Date:
• Institution: Transcript Request Date:
• Institution: Transcript Request Date:
H e a l t h S c i e n c e s D e p a r t m e n t
Kapi`olani Community College OCCUPATIONAL THERAPY ASSISTANT PROGRAM
Admission Application Checklist
12/12/2017
My external transcripts have been evaluated by KCC. Submit your transfer course report from STAR
accessible via the UH Portal (myuh.hawaii.edu).
My external transcripts have not been evaluated by KCC. Submit unofficial copies with this
application, send official copies to the KCC Kekaulike Information & Service Center, complete Online
request for Transcript Evaluation. To complete this form, you must log in with your UH Email
account. Complete this form at: http://makahiki.kcc.hawaii.edu:8080/opinio/s?s=4154
8. “My Plan Initiative.” Complete reflection essays and self assessments for your program/career pathway.
9. Interview and Writing Sample: After submitting your completed application, candidates may be invited
to participate in an interview with the Occupational Therapy Assistant Admissions Committee. Not all
applicants may be invited for an interview. If you qualify for an interview, you will be contacted by the
OTA Program to notify you when the interview will be held. A writing sample is required as part of the
application and will be administred on the same day as the interview.
_________ (initial)
10. Self-addressed, stamped #10 (4 1/8” X 9 1/2") envelope.
APPLICANT CERTIFICATIONS:
I certify that the answers and responses provided for all of the items on this Admission Application/Check List are true to the best of
my knowledge and belief. I understand that providing incorrect or false information will subject me to the requirements and/or discipline
measures as provided under the University’s Student Conduct Code. I understand that if I am not accepted into the program of
application, I must submit a new application and all required documents for any subsequent semester. I also allow KISC to change my
major and home institution if I am accepted into the OTA program. I understand that if I am not accepted into the OTA program, my
home institution and major will not change.
“Health care students are required to complete University prescribed academic requirements that involve practice
in a University affiliated health care facility setting with no substitution allowable for the completion required
clinical practice. Failure of a student to complete the prescribed clinical practices shall be deemed as not satisfying
academic program requirements. It is the responsibility of the student to satisfactorily complete any criminal
background checks and drug testing that may be required by the affiliated health care facility to which he/she is
assigned for clinical practice in accordance with procedures and timelines as prescribed by that affiliated health
care facility.”
I have read and understand the notification that a criminal background check and drug test may be required for entry into clinical
practice. I also understand that clinical practice is required for completion of this program. ________ (please initial)
I understand that priority selection is given to Hawai‘i State residents for tuition purposes and that non-residents will be considered
after all qualified residents have been accommodated per Board of Regents Policy. ________ (please initial)
Print Name ____________________________ Signature ________________________ Date_____________
EXAMPLE of how to complete the application:
These are the requirements Tell us what class you took to meet each requirement
Circle
Points
Course Alpha
Credits Earned
Semester & Year you took
course
Institution Name
Grade Points
RADIOLOGIC TECHNOLOGY PREREQUISITES A B C
ENG 100 Composition 1 (3cr ) WRI 1200 3.0 Fall 2011 Hawaii Pacific
University B 3 2 1
H e a l t h S c i e n c e s D e p a r t m e n t
12/12/2017
CRITERION FOR ACCEPTANCE:
Qualification is based on scores for completed prerequisite course grades, scheduled personal interview, and essay. Selection is based
on total qualifying scores in rank order from the highest score until admission quota is met for the Occupational Therapy Assistant
program.
Prerequisite Courses
Must be completed by application deadline.
Course
Alpha
Term of Completion
Where Completed
(i.e., Institution)
Grade/
Credits
Points
ENG 100 Composition I (3) 3 2 1
MATH 100 OR higher (3)
3 2 1
BIOL 130 Human Anatomy & Physiology (4)
OR
ZOOL 141 Human Anatomy & Physiology I (3)
AND
ZOOL 142 Human Anatomy & Physiology II (3)
3 2 1
BIOL 130L Human Anatomy & Physiology (1)
OR
ZOOL 141L Human Anatomy & Physiology I Lab (1)
AND
ZOOL 142L Human Anatomy & Physiology II Lab (1)
3 2 1
HLTH 118 Therapeutic Interpersonal Skills (3)
3 2 1
Overall Pre-requisite GPA:__________
Your grade point average (GPA) is calculated by dividing the total amount of grade points earned by the total amount of credit hours attempted.
A = 4 grade points / B = 3 grade points / C = 2 grade points
Points Awarded:
4.0-3.5 = 4 / 3.49-3.25 = 3 / 3.24-3.0 = 2 / 2.99-2.75 = 1
4 3 2 1
TOTAL POINTS
(out of a max of 19)
____/19
H e a l t h S c i e n c e s D e p a r t m e n t
Application Summary: For office use only
Date Received: _____________________ Ethnic Code: ____________ Counselor’s Initials: _________________ Application Complete: _____________ HI Resident: Y N KCC GPA Verified: _______________
Kapi‘olani Community College, Health Sciences and Emergency Medical Services Departments
4303 Diamond Head Road, Kauila 106 Honolulu, Hawai’i 96816-4421 Telephone: (808) 734-9224
Website: www.kapiolani.hawaii.edu
An Equal Opportunity/Affirmative Action Institution
Name: _____________________________________ UHID: ________________________________
Program: _______________________________________________________________
Please be clear and concise in your response for each reflective essay, limiting each question to 300 words.
Career Pathway Preparation
1. In a brief statement describe your career goals in this pathway. Where do
you see yourself in this career pathway in the next three years?
H e a l t h S c i e n c e s D e p a r t m e n t
Kapi`olani Community College MY PLAN
Reflection Essays
Career Pathway Attributes
2. In viewing “Health Careers at a Glance”, what are your strongest and
weakest “professional qualities” in your chosen career pathway? Please
describe these attributes; how do you plan to overcome your challenges,
how do you plan to improve on your strengths?
H e a l t h S c i e n c e s D e p a r t m e n t
Career Pathway Outlook
3. Describe any personal obstacles you face that may impact your current
academic success and how you plan to overcome these challenges? (I.e.
transportation, financial obligations, child care, time management). What
support systems do you have in place to overcome them?
H e a l t h S c i e n c e s D e p a r t m e n t
The purpose of the self-assessment is to discover your strengths and areas of focus. Working in healthcare requires a combination of academic skills, social skills, and a commitment to public service. As you plan, find ways to make your strengths shine and to improve your weaker areas. Consider discussing your self-assessment and reflective essays with a counselor to understanding how they support your academic and career goals.
Academic Strength Below
Expectations Meets
Expectations Exceeds
Expectations
Cumulative GPA Prerequisite Course GPA Completed prerequisites Completed support courses Writing abilityLetters of evaluation Awards/Achievements
Knowledge of the Profession Below
Expectations Meets
Expectations Exceeds
Expectations
Relevant experience – volunteer Relevant experience – for credit Relevant experience – paid Relevant Public service/Service Learning Understanding of current healthcare issues Comfort with bodily fluids Comfort with illness Comfort with injury Comfort with death Comfort with physical contact with people Ability to multitask and adapt to change
Personal Characteristics Below
Expectations Meets
Expectations Exceeds
Expectations
Commitment to public service Empathy/altruism Moral/ethical integrity Emotional maturity Responsibility Leadership Dedication/hard-working Commitment to life-long learning Ability to work as a team Personal interests & experience
H e a l t h S c i e n c e s D e p a r t m e n t
Kapi`olani Community College MY PLAN
Self - Assessment
Updated: 10/30/2017 Information is subject to change without notice.
HEALTH CAREERS @ A GLANCE FOR HEALTH SCIENCES/EMS
HEALTH CAREERS COUNSELING CENTER
Program Health Services
Occupational Cluster
Professional Qualities Starting
Semester Application
Period Selection Process
Selection Criteria
Qualification Requirements Prerequisites
Suggested Support Courses
Degree (Credits)
Dental Assisting (DENT) Therapeutic Dental
Professional Attitude Time Management
Compassion Flexibility
Adapt to Changes Ability to Multitask
Fall Dec 1 - June 30 Best Qualified, First Accepted
Cumulative Score from Completed
Prerequisites
Accuplacer WritePlacer score
of 4 + None
CC: 15 CA:41
Emergency Medical Technician
(EMT)
Therapeutic Direct Patient Care
Integrity Empathy
Self Motivation Appearance & Hygiene
Self Confidence Time Management
Communication Skills Teamwork & Diplomacy
Respect Patient Advocacy
Fall Spring
Summer 2018
Dec 1 - June 1 June 2 - Oct 1 Oct 2 - Jan 8
Best Qualified, First Accepted
Cumulative Score from Completed
Prerequisites, Sup-plemental Applica-
tion Requirements, & Interview
Placement into MATH 32, 82, or higher; or com-pletion of MATH
32 or higher (placement into only MATH 75x does not meet qualification
criteria). Must be w/in last two
years.
English 100 Health 125 None CC:13
Medical Assisting (MEDA)
Therapeutic Patient Care, Health Info & Diagnostic
Compassion Attention to Detail Ability to Multitask,
Organizational Skills, Good Verbal & Written Communication Skills
Adaptability & Flexibility
Fall Dec 1—March 1 Best Qualified, First Accepted
Qualifying Scores/Courses
Qualification for ENG 100 &
Qualification for MATH 32 or
higher; (within last two years) Or evidence of course comple-
tion
None CA:33 AS:64
Medical Laboratory
Technician (MLT) Diagnostic Laboratory
Attention To Detail Integrity
Dependability Good Verbal & Written Communication Skills
Self-Starter Ability To Multi-Task
Spring June 1—Sept 1 Best Qualified, First Accepted
Cumulative Score from Completed Prerequisites &
Support Courses
None
ENG 100 or ESL 100 MATH 103 or higher CHEM 161 + 161L MLT 100
CHEM 162 + 162L MICR 130 MICR 161
AS/SS AS/AH
AS:70-73
Mobile Intensive Care Technician
(MICT)
Therapeutic Direct Patient Care
Integrity Empathy
Self Motivation Appearance & Hygiene
Self Confidence Time Management
Communication Skills Critical Thinking * Problem
Solving Skills Teamwork & Diplomacy
Respect Patient Advocacy
Spring June 1—Oct 1
(every other year) Best Qualified, First Accepted
Cumulative Score from Completed
Prerequisites, Sup-plemental Applica-
tion Requirements, & Interview
None
ENG 100 HLTH 125 MATH 103 EMT 100 EMT 101
FAMR 230 AS/AH
CA: 40.33 AS:71.33-
75.33
Placement into MATH 32, 82, or
higher; or comple-tion of MATH 32 or higher (placement
into only MATH 75x does not meet qualification crite-
ria).
BIOL 130 or BIOL 171 or ZOOL 141 & ZOOL 142
BIO 130 + 130L or ZOOL 141,141L, & 142,142L
All programs give priority seating to qualified Hawai`i state residents. Each student should develop a “My Plan” with the Health Sciences/Nursing Counselor(s) for their intended program/career pathway.
Updated: 10/30/2017 Information is subject to change without notice.
HEALTH CAREERS COUNSELING CENTER
Program Health Services Occupational
Cluster Personal Qualities
Starting Semester
Application Period
Selection Process
Selection Criteria
Qualifying Placement /Tests Prerequisites
Suggested Support Courses
Degree (Credits)
Occupational Therapy Assistant
(OTA)
Therapeutic Rehabilitation
Able to Relate & Engage With People; “people person”
Self Motivated & Responsible Organizational Skills
Commit To Rigorous Study Communication Skills Critical Thinking Skills Creative & Adaptability
Teamwork Skills
Fall April 1—May 30 Best Qualified, First Accepted
Qualifying Scores/Courses
None
ENG 100 or ESL 100 MATH 100 or higher HLTH 118
BIOL 130, 130L or ZOOL 141,141L + 142,142L
HLTH 125 OTA 110 OTA 119 AS/AH FAMR 230
CC: 5 AS: 70-72
Physical Therapist Assistant (PTA)
Therapeutic Rehabilitation
Accountability Altruism
Compassion and Caring Culture Competence
Duty Integrity
Social Responsibility Communication Problem Solving
Fall Apr 1—May 25 Best Qualified, First Accepted
Cumulative Score from Completed Prerequisites &
Observation Reference Score
None
ENG 100 or ESL 100 MATH 103 or higher SP 181 FAMR 230 ZOOL 141,141L, 142,142L
PTA 101W HLTH 120 HLTH 125 HLTH 290, 290L AS/AH
None AS:72
Radiologic Technician
(RAD) Diagnostic Imaging
Communication Skills Compassion
Hand-Eye Coordination and Visualization
Acute Problem Solving Skills/Ability to Adapt
Function Under Pressure Good Work Ethic
Fall Apr 1—May 31 Best Qualified, First Accepted
Cumulative Score from Completed Prerequisites &
Support Courses, & A2 Exam
HESI A2 Exam ENG 100 or ESL 100 MATH 135 or higher HLTH 125
BIOL 130 + 130L or ZOOL141,141L, 142,+142L
AS/AH AS/SS AS: 85-88
Respiratory Care Practitioner
(RESP)
Therapeutic Direct Patient Care
Communication Skills Compassion and Caring
Culture Competence Ability to Adapt
Ability to Multitask Organizational Skills
Problem Solving Skills Integrity
Teamwork & Diplomacy Good Work Ethic
Summer April 1— May 30 Best Qualified, First Accepted
Cumulative Score from Completed Prerequisites,
Interview, Essay, & Evidence of
Degree Earned
None
ENG 100 or ESL 100 MATH 100 or higher HLTH125 or HLTH110 PSY100 or FAMR230 CHEM100 or higher
ZOOL141,141L, 142,+142L MICR 130 or MICR 135 MICR 140 AS/AH
None AS: 95-96
All programs give priority seating to qualified Hawai`i state residents. Each student should develop a “My Plan” with the Health Sciences/Nursing Counselor(s) for your intended program/career pathway.
HEALTH CAREERS @ A GLANCE FOR HEALTH SCIENCES/EMS