LAKE TECHNICAL COLLEGE


2018-2019

MASTER PLAN OF INSTRUCTION

FIRE FIGHTER / EMERGENCY MEDICAL TECHNICIAN COMBINED PROGRAM


Dr. Diane Culpepper, Lake Technical College Executive Director Ron Williams, Fire Program Training Director

Layne Hendrickson, EMS Program Coordinator


Lake Technical College is accredited by the Commission of the Council of Occupational Education MISSION STATEMENT

The mission of Lake Technical College is to be an integral component of the economic growth and development in our community by offering a variety of high quality career-training opportunities.


Lake Technical College does not discriminate on the basis of race, religion, color, national origin, gender, genetic information, age, pregnancy, disability, or marital status in its educational programs, services or activities, or in its hiring or employment practices. The district also provides access to its facilities to the Boy Scouts and other patriotic youth groups, as required by the Boy Scouts of America Equal Access Act, or any other youth group listed in Title 36 of the United States Code as a patriotic society.

FIRE FIGHTER / EMERGENCY MEDICAL TECHNICIAN COMBINED PROGRAM

The Fire Fighter/EMT Combined Program is a 698-hour program offering a sequence of 4 courses with 3 occupational completion points. The program is comprised of comprehensive courses consisting of lectures, practical “LIVE” fire training, and EMT clinical rotation and field internship. Graduates will be eligible to take the state firefighter certification and state EMT certification National Registry examination.


OCP Course Course Title Length SOC

Number Code

A

FFP0010

Fire Fighter I

206

hours

33-

2011

B

FFP0020

Fire Fighter II

192

hours

33-

2011

C

EMS0110

Emergency Medical Technician

300

hours

29-

2041


Lake Technical College’s Capstone Test Prep Class of 47 hours is available upon completion of OCP A and B.


Per Florida Statue 633.34.6, to become a Fire Fighter in the State of Florida, an individual must be a non-user of tobacco, and the individual must sign an affidavit stating he/she is not a user of tobacco.


ADMISSION CRITERIA

To apply for admission into the Fire Fighter/EMT Combined Program, each applicant must:


Be at least 18 years of age, unless a dual-enrolled high school senior and 17 years old. A qualified high school student may be eligible if he/she has met all academic requirements for graduation. Dual-enrolled applicant must be 18 years old to test for fire certification and prior to beginning of the Emergency Medical Technician

(EMS0159) course.

Have earned a high school diploma or its equivalent.

Be of good moral character.

Possess a valid Florida driver’s license. Note: Applicant must be a resident of Florida for at least one year to pay in-state tuition rate.

Take the TABE test, level 10 in all subjects, A level TABE

Take the National Firefighter Selection Inventory (NFSI) test and must attain a score of 70% or higher to qualify for admission. Prior firefighting or medical knowledge is not required for the test. Three retests are allowed within six months. The test is given at Lake Technical College’s (LTC) main campus in Eustis. Call LTC (352.589.2250) for information about the testing fee and schedule

Submit to a fingerprint background check. See Florida Statute 633 excerpt (page 3 of this document) related to background check.

Submit to a drug screening. Additional drug screenings may be required during the program if suspicion warrants.

If at any time the student’s drug test is positive and has not been medically approved, the student will be withdrawn from the program. NOTE: Students are responsible for payment of all fees related to drug screening.

Have passed a physical examination including EKG and hearing test by a licensed Florida physician, physician

assistant, or nurse practitioner within six months of the starting date of the program, meeting the requirements of the Division of State Fire Marshal Bureau of Fire Standards and Training Medical Examination Form. The applicant is required to provide documentation of mandatory shots and immunization prior to beginning the Emergency Medical Technician (EMS0110) course.

Current Professional CPR card

Submit a driver’s license history with the application packet. This must be an official certified record from a Courthouse. An applicant with excessive points or license suspended within the last three years will be disqualified.

Complete LTC’s online school application.

Along with the completion of the above-listed admission criteria, an applicant must submit a completed LTC’s Fire Fighter/EMT Combined Program application for conditional acceptance into the program.


Florida Statute 633 (excerpt) Firefighter Certification; Qualification for Certification


Final admission to the Fire Fighter/EMT Combined Program BASED ON THE FOLLOWING: Students are accepted into the Firefighting program on a conditional admission basis. Final admission is contingent upon passing the Simulated Candidate Physical Ability Test (SCPAT), refer to the Lake Tech web site for details, and receiving a clear background check.


Untruthfulness or omissions on the LTC or program application will be grounds for dismissal if applicant is admitted to the program.


GENERAL INFORMATION

ACCOMMODATIONS

Federal and state legislation require the provision of accommodations for students with disabilities as identified on the secondary student’s IEP/504 plan or postsecondary student’s accommodations plan to meet individual needs to ensure equal access. Postsecondary students with disabilities must self-identify, present documentation, request accommodations if needed, and develop a plan with their postsecondary provider.


Students desiring accommodations or updates to their accommodations are encouraged to self-identify as early in the program as possible. In order to receive disability accommodations, students must self-disclose the disability to the Students with Disabilities Coordinator and provide documentation that clearly shows evidence of a disability and applicable accommodations. The Students with Disabilities Coordinator will schedule a meeting with the student and faculty to discuss the documented disability and applicable accommodations.


Accommodations received in postsecondary education may differ from those received in secondary education. Accommodations change the way the student is instructed. Students with disabilities may need accommodations in such areas as instructional methods and materials, assignments, assessments, time demands, schedules, learning environment, assistive technology, and special communication systems. Documentation of the accommodation requested and provided is maintained in a confidential file.


INSURANCE

Due to the high-risk nature of training, personal accident insurance is required. Hospitalization/accidental medical insurance is optional. For those who don’t have insurance, a low cost plan is available. See the Admissions Office at Lake Technical College’s main campus.


FINANCIAL AID

Policies and guidelines for the administration of all financial aid are established according to federal and state law. Applicants complete an information form, Free Application for Federal Student Aid, and furnish documentation needed to verify eligibility. More information on the application process may be obtained in the Financial Aid Office.


The Financial Aid Office will assist students, where possible, with access to financial support offered by federal agencies (U.S. Department of Education – Pell Grants, Department of Veterans’ Affairs), other state and local agencies and local organizations (scholarships). For information on financial services, contact the Financial Aid Office at Lake Technical College’s main campus 352.589.2250.


TEST OF ADULT BASIC EDUCATION (TABE)

All applicants for Career and Technical Education (CTE) programs 450 hours or more, with the exception of Florida Law Enforcement Academy applicants, take a state mandated TABE prior to enrollment. TABE scores are good for two years and must be valid at the time of enrollment.

Several exemptions to TABE are accepted. In order to be exempt, a student must submit official documentation to a career advisor for verification of an exemption:

  1. Applicants who have earned a standard State of Florida high school diploma, 2007 or later, or possess a documented degree (AA, AS, AAS, BA or BS) may be exempt from TABE testing. (s.1004.91).

  2. Applicants who have earned a State of Florida High School diploma via the GED® test no more than two years prior to the start of class.

  3. Students taking any accepted standardized tests such as PERT or ACT may be exempt from the TABE provided the scores are at satisfactory levels and the test was taken within two years of enrollment in a Career and Technical Education program (6A-10315, 6A-10.040).

  4. A student who has completed or who is exempt from the college-level communication and computation skills (CLAST) examination pursuant to s.1008.29 is also exempt from the TABE. Per s. 1008.29.

  5. Documented successful completion of college-level remedial coursework may be used to meet TABE requirement.

  6. Documented passing scores on state-designated industry certification tests may be used.

  7. Mandated TABE exit scores may be waived for documented special needs students as per Florida guidelines. The student must enroll in AAAE and begin remediation in order to meet the exit requirements of the CTE program in which the student is enrolled. A student, with a documented disability, who is approaching completion (mastered 90% of the competencies) of the CTE program and has not met TABE scores, may be considered for a TABE exemption based on the following. It is determined through a SIT meeting that the student has successfully mastered the competencies of the CTE program in which she/he is enrolled and has been participating as expected in AAAE. The members of the SIT meeting may agree to waive TABE requirements.

According to Florida Department of Education rules, students who fail all or parts of the TABE may only retest using a different TABE version after 60 documented hours of remediation in the Applied Academics for Adult Education (AAAE) lab or three months if not attending AAAE. Students may not retake the same test version for six months.

We, therefore, strongly recommend that students test early, especially for licensure programs, in order to allow time for remediation and retesting should the need arise.

Students who do not meet the minimum TABE scores set by the Florida Department of Education for their program must begin attending remediation classes in the AAAE lab prior to or at the time of enrollment in a Career and Technical Education class for at least one block a day and make acceptable progress as determined by the AAAE faculty. It is highly recommended students meet state mandated TABE requirements by the time they have completed 50% of their program. Students who do not meet state mandated TABE scores may not receive a certificate of completion as per Florida Department of Education rules.

Applicants transferring appropriately leveled TABE, PERT or other accepted standardized test scores from other testing centers must do so by having an official score report sent directly to the Admissions Office prior to enrollment in the program. Scores brought by hand will be accepted only if document provided by the outside testing center is in a sealed envelope. Standardized tests scores are valid for two years.

TABE scores are good for two years and must be valid at the time of enrollment. TABE scores that expire during continuous enrollment remain valid until the end of such enrollment. Under continuous enrollment, students must be enrolled at least 50% of each semester per school year. Continuous enrollment applies to attendance in a single program.

The TABE exit scores for this program are reading 10; math 10; and language 10.


TUITION

Tuition is charged for adult students at a rate established by the State legislature. Current fee information is available in the Admissions Office. Tuition is waived for eligible high school dual enrolled students. Tuition is due prior to the first day of each semester based on the Lake Technical College payment calendar. Failure to pay all fees due at the time class begins will result in not being able to attend class and/or clinical, if applicable.


REFUND POLICY

If it becomes necessary for a student to withdraw from the program, the tuition refund may be given using the following applicable guidelines (excerpts from the LTC refund policy guidelines):


Due to the hazardous nature of the training, students involved in a gross safety violation that may result in injury to other students or instructional staff may be exited from the program IMMEDIATELY upon documentation of such acts.


The staff at Lake Technical College takes great pride in the Fire Fighter/EMT Combined Program and its students. The staff has the responsibility to train students to be professional firefighters and EMTs and to certify that students will be a credit to the program and the profession. During the class, students who are not meeting the professional standards, whether academic, practical, or attitude, will be counseled. If improvement is not made, the student may be dismissed from the program.

Students enrolled in this program are training to enter a dangerous, responsible, adult occupation in which the civilian public, as well as your work partners, will be dependent upon your ability. With this in mind, use your training hours wisely.


If any problems arise during the course of the program, students may contact the Lake Technical College’s Institute of Public Safety staff members or administrators at 352.742.6463 or Lake Technical College’s EMS Program Coordinator or College administrators at 352.589.2250.


FIRE FIGHTER/EMT COMBINED PROGRAM INFORMATION


Time Allotted 698 hours



Program Oversight

Fire Program Training Director Ron W illiams, 352-742-6463 ext. 1925

EMS Program Coordinator Layne C. Hendrickson, 352-589-2250 ext. 1881 EMS Program Medical Director Desmond Fitzpatrick, M.D.


Methods of Instruction Lectures/Discussions Demonstration/Role Playing Simulation

Collaborative Learning Cooperative Learning Case Studies

Problem-Based and Inquiry Learning


Clinical- Hospital-based Patient Care


Field Internship – ALS Prehospital Care and Transport


Textbooks

Essentials of Fire Fighting & Fire Department Operations (ED.6)

ISBN: 9780133140804

ISBN10: 0133140806


Essential of Fire Fighting 6th Edition Exam Prep

ISBN: 9780879395100

ISBN10: 0879395109


Emergency Care + My Brady Lab 13ed. ISBN 9780134190754

2018 - 2019

Florida Department of Education Curriculum Framework


Program Title: Fire Fighter/ Emergency Medical Technician- Combined Program Type: Career Preparatory

Career Cluster: Law, Public Safety, & Security/ Health Science


PSAV

Program Number

P430216

CIP Number

0743020312

Grade Level

30, 31

Standard Length

698 Hours

Teacher Certification: OCPs A&B

Refer to the Program Structure section.

Teacher Certification: OCPs C & D

Refer to the Program Structure section.

CTSO

FPSA and HOSA

SOC Codes (all applicable)

33-2011 Fire Fighters

29-2041 Emergency Medical Technicians and Paramedics 31-9099 Healthcare Support Workers, All Other

CTE Program Resources

http://www.fldoe.org/academics/career-adult-edu/career-tech-edu/program- resources.stml

Basic Skills Level

Mathematics: 10

Language: 10

Reading: 10

# These certifications can only be used for adjunct faculty. Please refer to 64J-1.201 F.A.C. for the EMS instructor qualifications.


Purpose

The purpose of this program is to provide the necessary training required for students to become certified firefighters as well as licensed Emergency Medical Technicians. It is not intended for those who are currently certified/licensed as either firefighters or EMTs. Students wishing to add an additional certification to an existing credential must enroll in either the Fire Fighter I/II program or the Emergency Medical Technician program.


This program offers a sequence of courses that provides coherent and rigorous content aligned with challenging academic standards and relevant technical knowledge and skills needed to prepare for further education and careers in the Law, Public Safety and Security and Health Science career clusters; provides technical skill proficiency, and includes competency-based applied learning that contributes to the academic knowledge, higher-order reasoning and problem-solving skills, work attitudes, general employability skills, technical skills, and occupation-specific skills.


Program Structure

This program is a planned sequence of instruction consisting of 3 occupational completion points.


This program is comprised of courses which have been assigned course numbers in the SCNS (Statewide Course Numbering System) in accordance with Section 1007.24 (1), F.S. Career and Technical credit shall be awarded to the student on a transcript in accordance with Section 1001.44(3)(b), F.S. (NOTE: Bureau of Fire Standards and Training (BFST) course number system on their frameworks is not the same as SCNS. Ensure to report the FDOE SCNS Course Number.)


To teach the courses listed below, instructors must hold at least one of the teacher certifications indicated for that course.


The following table illustrates the postsecondary program structure:

OCP


Course Number


Course Title


Teacher Certification


Length

SOC Code

A

FFP0010

Fire Fighter I

FIRE FIGHT 7G

206 hours

33-2011

B

FFP0020

Fire Fighter II

192 hours


C


EMS0110


Emergency Medical Technician

PARAMEDIC @7 7G # EMT 7G

# REG NURSE 7 G

# PRAC NURSE @7 %7%G

*(Must be a Registered Nurse)


300 hours


29-2041


Regulated Programs


Fire Fighter Regulation

Pursuant to 633.128, Florida Statutes, the Department of Financial Service, Division of State Fire Marshal, has established training requirements for firefighters and volunteer firefighters. These requirements are implemented by Rule 69A-37.055, Florida Administrative Code. This program is a planned sequence of instruction consisting of two occupational completion points. (NOTE: The curriculum frameworks are subject to change by the Bureau of Fire Standards and Training (BFST) in accordance with statutory or Florida Administrative Code (F.A.C.) rule changes.)


EMT Regulation

The EMT component of this combined program prepares students for certification as EMT's in accordance with Chapter 64J of the Florida Administrative Code. The program must be approved by the Department of Health, Office of Emergency Medical Services, and the curriculum must adhere to the US Department of Transportation

(DOT), National EMS Education Standards for EMT. This is the initial level for a career in emergency medical services and the primary prerequisite for paramedic training and certification.


The EMT component of this program meets the Department of Health trauma score card methodologies and Sudden Unexpected Infant Death Syndrome training education requirements. Upon completion of this component, the instructor will provide a certificate to the student verifying that these requirements have been met. Programs may also teach domestic violence and prevention of medical errors education and may choose to provide a certificate to the student verifying that this education has been completed.


Please refer to chapter 401 F.S. for more information on disqualification for the EMT license through the Office of Emergency Medical Services, Department of Health.


The EMT component of this program must be taught by an instructor meeting the qualifications as set forth in 64J- 1.0201 FAC.


An American Heart Association or Red Cross certification or equivalent in "professional" Basic Life Support is required of all candidates for entrance into the EMT component of this program.


The Student Performance Standards for Emergency Medical Technician were adapted from the US Department of Transportation (DOT) National EMS Educational Standards for EMT.


Florida Statute 401.2701 requires that the instructor-student ratio should not exceed 1:6. Hospital activity shall include a minimum of 20 hours of supervised clinical supervision, including 10 hours in a hospital emergency department.

Clinical activity shall include appropriate patient assessment skills, intervention and documentation relevant to each clinical rotation.


Field internship shall include a competency based program to assure appropriate pre-hospital assessment and management of medical and trauma patients, as well as associated manual skills. The field internship activity shall include a minimum of 5 emergency runs resulting in patient care and transport appropriate for the EMT. In addition, the patient care component should include minimum competencies in patient assessment, airway management and ventilation, trauma and medical emergencies.


Common Career Technical Core – Career Ready Practices


Career Ready Practices describe the career-ready skills that educators should seek to develop in their students. These practices are not exclusive to a Career Pathway, program of study, discipline or level of education. Career Ready Practices should be taught and reinforced in all career exploration and preparation programs with increasingly higher levels of complexity and expectation as a student advances through a program of study

Standards


Fire Fighter Component

The Bureau of Fire Standards and Training (BFST) approved curricula is available at:


Fire Fighter I: http://www.myfloridacfo.com/Division/SFM/BFST/Training/documents/Syllabus_FirefighterPartI.pdf

Fire Fighter II: http://www.myfloridacfo.com/Division/SFM/BFST/Training/documents/Syllabus_FirefighterPartII.pdf


Emergency Medical Technician Component

01.0 Demonstration of a simple depth and foundational breadth of EMS systems.

02.0 Demonstration of a simple depth, simple breadth of research and evidence-based decision making.

03.0 Demonstration of a fundamental depth, foundational breadth of workforce safety and wellness.

04.0 Demonstration of a fundamental depth, foundational breadth of the principles of medical documentation and report writing.

05.0 Demonstration of a simple depth, simple breadth of the EMS communication system, communication with other health care professionals, and team communication.

06.0 Demonstration of a simple depth and simple breadth of the principles of therapeutic communication.

07.0 Demonstration of a fundamental depth, foundational breadth of medical legality and ethics.

08.0 Demonstrate the application of fundamental knowledge of the anatomy and function of all human systems to the practice of EMS.

09.0 Demonstrate the application of fundamental knowledge in the use of medical terminology and medical terms.

10.0 Demonstrate the application of a fundamental knowledge of the causes, pathophysiology and management of shock and the components of resuscitation.

11.0 Demonstrate the application of fundamental knowledge of life span development to patient assessment and management.

12.0 Demonstrate the use of simple knowledge of the principles of illness and injury prevention in emergency care.

13.0 Demonstrate a simple depth, simple breadth for medication safety and kinds of medications used during an emergency.

14.0 Demonstrate a fundamental depth and foundational breadth of medication administration within the scope of practice of the EMT.

15.0 Demonstrate a fundamental depth and simple breadth of emergency medications within the scope of practice of the EMT.

16.0 Demonstrate a foundational depth, foundational breadth of airway management within the scope of practice of the EMT.

17.0 Demonstrate a fundamental depth, foundational breadth of respiration.

18.0 Demonstrate a fundamental depth, foundational breadth of assessment and management utilizing artificial ventilation.

19.0 Demonstrate a fundamental depth, foundational breadth of scene management and multiple patient situations.

20.0 Demonstrate a fundamental depth, simple breadth of the primary assessment for all patient situations.

21.0 Demonstrate a fundamental depth, foundational breadth of the components of history taking.

22.0 Demonstrate a fundamental depth, foundational breadth of techniques used for a secondary assessment.

23.0 Demonstrate a simple depth, simple breath of monitoring devices within the scope of practice of the EMT.

24.0 Demonstrate a fundamental depth, foundational breadth of how and when to perform a reassessment for all patient situations.

25.0 Demonstrate a simple depth, foundation breadth of pathophysiology, assessment and management of medical complaints.

26.0 Demonstrate a fundamental depth, foundational breadth of the assessment and management of neurologic disorders/emergencies for all age groups.

27.0 Demonstrate a fundamental depth, foundational breadth of the assessment and management of abdominal and gastrointestinal disorders/emergencies for all age groups.

28.0 Demonstrate a fundamental depth, foundational breadth of the assessment and management of immunology disorders/emergencies for all age groups.

29.0 Demonstrate a simple depth, simple breadth of the assessment and management of a patient who may have an infectious disease for all age groups.

30.0 Demonstrate a fundamental depth, foundational breadth of the assessment and management of endocrine disorders/emergencies for all age groups.

31.0 Demonstrate a fundamental depth, foundational breadth regarding the assessment and management of psychiatric emergencies for all age groups.

32.0 Demonstrate a fundamental depth, foundational breadth of the assessment and management of cardiovascular emergencies for all age groups.

33.0 Demonstrate a fundamental depth, foundational breadth of the assessment and management of toxicological (poisoning and overdose) emergencies for all age groups.

34.0 Demonstrate a fundamental depth, foundational breadth of the assessment and management of respiratory disorders/emergencies for all age groups.

35.0 Demonstrate a simple depth, simple breadth of the assessment, and management of hematology disorders for all age groups.

36.0 Demonstrate a simple depth, simple breath of the assessment and management of genitourinary/ renal emergency for all age groups.

37.0 Demonstrate a fundamental depth, foundational breadth of the assessment and management of gynecologic emergencies for all age groups.

38.0 Demonstrate a fundamental depth, foundational breadth of the assessment and management of non-traumatic fractures for all age groups.

39.0 Demonstrate a simple depth, simple breadth in recognition and management of nose bleed for all age groups.

40.0 Demonstrate the application of fundamental knowledge of the causes, pathophysiology, and management of shock and respiratory failure.

41.0 Demonstrate a fundamental depth, foundational breadth of pathophysiology, assessment and management of the trauma patient for all age groups.

42.0 Demonstrate a fundamental depth, foundational breadth of pathophysiology, assessment, and management of bleeding for all age groups.

43.0 Demonstrate a fundamental depth, simple breadth of pathophysiology, assessment and management of chest trauma for all age groups.

44.0 Demonstrate a fundamental depth, simple breadth of pathophysiology, assessment and management of abdominal and genitourinary trauma for all age groups.

45.0 Demonstrate a fundamental depth, foundational breadth of pathophysiology, assessment, and management of orthopedic trauma for all age groups.

46.0 Demonstrate a fundamental depth, foundational breadth of pathophysiology, assessment, and management of soft tissue trauma for all age groups.

47.0 Demonstrate a fundamental depth, foundational breadth of pathophysiology, assessment, and management of head, facial, neck and spine trauma for all age groups.

48.0 Demonstrate a fundamental depth, foundational breadth of pathophysiology, assessment, and management of nervous system trauma for all age groups.

49.0 Demonstrate a fundamental depth, foundational breadth of pathophysiology, assessment and management of trauma patients with special considerations for all age groups.

50.0 Demonstrate a fundamental depth, foundational breadth of pathophysiology, assessment and management of environmental emergencies for all age groups.

51.0 Demonstrate a fundamental depth, foundational breadth of the pathophysiology, assessment, and management of multi-system trauma and blast injuries.

52.0 Demonstrate a fundamental depth, foundational breadth of management of the obstetric patient within the scope of practice of the EMT.

53.0 Demonstrate a fundamental depth, foundational breadth of management of the newborn and neonatal patient within the scope of practice of the EMT.

54.0 Demonstrate a fundamental depth, fundamental breath of management of the pediatric patient within the scope of practice of the EMT.

55.0 Demonstrate a fundamental depth, foundational breadth of management of the geriatric patient within the scope of practice of the EMT.

56.0 Demonstrate a simple depth, simple breadth of management of the patient with special challenges.

57.0 Demonstrate a simple depth, foundational breadth of risks and responsibilities of transport.

58.0 Demonstrate a fundamental depth, fundamental breadth of establishing and working within the incident management system.

59.0 Demonstrate a simple depth, foundational breadth of responding to an emergency during a multiple casualty incident.

60.0 Demonstrate a simple depth, simple breadth of safe air medical operations and criteria for utilizing air medical response.

61.0 Demonstrate a simple depth, simple breadth for safe vehicle extrication and use of simple hand tools.

62.0 Demonstrate a simple depth, simple breadth of risks and responsibilities of operating in a cold zone at a hazardous material or other special incident.

63.0 Demonstrate a simple depth, simple breadth of risks and responsibilities of operating on the scene of a natural or man-made disaster.

LAKE TECHNICAL COLLEGE


FIRE FIGHTER / EMT COMBINED PROGRAM


STATEMENT OF UNDERSTANDING


I attest that I have received a copy of the Lake Technical College Fire Fighter/EMT Combined Program’s Master Plan of Instruction and Code of Student Conduct. I know it is my responsibility to understand the rules and regulations and any infractions of the aforementioned rules and regulations may result in disciplinary actions as outlined in the Master Plan of Instruction. I also understand that I cannot be a user of tobacco and enrolled in this program.


STUDENT’S NAME - PRINTED DATE


STUDENT’S SIGNATURE


LAKE TECHNICAL COLLEGE STAFF DATE