Dental Assisting Application - Fall 2023 - Deadline April 21

1. Dental Assisting Clinical Application

By completing this form you are applying for the dental assisting clinical program. If you have any questions regarding your application, please contact Rebecca Small - RPSMALL@hacc.edu - prior to April 21.

All applicants will be notified via HAWKMAIL ONLY of the committee's decision after May 1. Please check your Hawkmail daily!

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* 1. Please enter your information here. PLEASE LIST YOUR HAWKMAIL email address ONLY and check that email daily.

First Name: *

Last Name: *

Address: *

Address 2:

City/Town: *

State: *

ZIP/Postal Code: *

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

Phone Number: *

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* 2. HACC ID (Begins with H)

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* 3. I have met with the program director, Rebecca Small, and have an educational plan.

Yes

If no, please explain:

A 4-hour shadowing experience is optional. All shadowing forms must be received by the Dental Assisting office prior to April 21.

The shadowing form can be found on the last page of the admission criteria document or find the link on the CONGRATULATIONS page after you click DONE on this application. Completed forms must be returned to Ms. Small prior to April 21.

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* 4. Do you plan to, or have you completed a 4-hour shadowing experience?

Yes

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* 5. Did you complete a dental assisting program at a career & technology center (CTC)? Official transcripts MUST be on file in the Admissions Office prior to April 21.

Yes

List name/location of school

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* 6. Did you complete a health care program (other than dental assisting) at a career & technology center (CTC)? Official transcripts must be received by the Admissions Office (admission@hacc.edu) prior to April 21.

Yes

List name/location of school

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* 7. Do you have an Associate's (or higher) degree from a regionally accredited college? Official transcripts must be submitted to and evaluated by the Records Office prior to April 21.

Yes

What school and major?

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

Yes

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* 9. Did you complete DH100 or Intro to Dentistry AH CE 149 (Workforce/Non-credit) with a “C” grade/PASS or better?

Neither

DH 100

Intro to Dentistry (Workforce)

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