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