Dental Hygiene Clinical Application-Fall 2021

1. HACC DENTAL HYGIENE CLINICAL APPLICATION

You are applying for the FALL 2021 Dental Hygiene clinical program.

You must have attended a mandatory dental hygiene application information session and have already taken the TEAS. If you have not taken the TEAS yet please stop now and apply after you've taken it. The minimum score required to apply is 62. The highest score achieved as of the time of this application will be used in calculating your points. All TEAS scores are verified on the ATI website. You may apply ONE time.

All shadowing forms and Verification of Clinical Dental Assisting Hours forms must be received by the dental hygiene program PRIOR to submitting the application.

All applicants will be notified VIA EMAIL using only the provided Hawkmail account of the committee’s decision on or around April 1.

If you have any questions regarding your application, please see a health career advisor prior to March 15.

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* 1. DENTAL HYGIENE - Please enter your information here. PLEASE LIST YOUR HAWKMAIL email address. If you haven't activated it yet, do that NOW.

First Name: *

Last Name: *

HACC ID *

Address:

City: *

State: *

ZIP: *

HAWKMAIL Email Address (ends with @hawkmail.hacc.edu): *

Phone with area code: *

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* 2. Maiden name or previously used name

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* 3. Have you previously applied for HACC dental hygiene clinicals?

Yes

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* 4. What was your TEAS TOTAL (or composite) SCORE? (will be verified on the ATI website). The highest score as of this application will be used to calculate your points. A minimum score of 62 is required to apply.

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* 5. Which have you completed? All shadowing documentation forms must be received in the Dental Hygiene office prior to March 15.

300 hours of documented experience as a clinical dental assistant in an office that employs a dental hygienist

10 hours of observation time (shadowing)

Comments

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* 6. Are you a DANB Certified Dental Assistant (having successfully passed all three exam components including general chairside, radiology, and infection control)?

Yes

If yes, provide your certification number (and previous name if different than name on this application).

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* 7. Have you completed an ADA accredited dental assistant program with an overall GPA of 3.0 AND subsequent nine (9) months full-time (32 hours/week) experience?

Yes

Comments

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* 8. If the answer to the previous question was yes, please enter the job title, and years, months and hours per week of employment. Verification form (from the website) must be received in the Dental Hygiene Office by March 15.

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* 9. Have you ever been enrolled in the clinical portion of a health career program at HACC which you did not complete/graduate?

Yes

If yes, which program?

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* 10. Have you taken DH 100 OR Introduction to Dentistry (AH CE 179) through Workforce Development?

I took DH 100 (1 credit)

I took Intro to Dentistry (Workforce/noncredit)

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* 11. Have you taken English 101 or equivalent

I took English 101 (or equivalent) and received a grade of C or higher)

I am currently taking English 101

I have not yet taken English 101

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* 12. Have you taken Anatomy and Physiology I (BIOL 121 or equivalent)

I took Anatomy and Physiology I (or equivalent) and received a grade of C or higher)

I am currently taking Anatomy and Physiology I

I have not yet taken Anatomy and Physiology I

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* 13. Have you taken Microbiology (BIOL 221 or equivalent)

I took Microbiology (or equivalent) and received a grade of C or higher)

I am currently taking Microbiology

I have not yet taken Microbiology

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* 14. Math placement

I have successfully passed MATH 090/091/055 or tested out of math placement

I am currently taking development math courses (MATH 090/091)

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* 15. English/Reading placement

I have successfully passed ENGL 003 and/or ENGL 057/ENGL 051 or tested out of reading/writing placement

I am currently taking developmental English courses (ENGL 051/ENGL 003/ENGL 057)

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* 16. Have you attended a mandatory information session?

Yes

Please list date attended (if known)

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* 17. Chemistry

I took Chemistry in high school (academic or honors - with a C or better within the past 7 years)

I took CHEM 100 at HACC

Other (please specify)