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Associate of Applied Science Degree Dental Hygiene Application Fall 2017 Open date: Friday, July 1, 2016 | Applicants can begin submitting program applications. Close date: Thursday, December 22, 2016 | All required documentation listed on the application checklist must be received by the Admissions, Registration and Records office no later than 5 p.m. No postmark date allowed, no exceptions. Please note: This application is for a restricted entry program, and must be filled out by hand and submitted, along with supporting documents and payment to Mt. Hood Community College’s Admissions, Registration and Records Office, 26000 SE Stark St, Gresham OR 97030. People requiring accommodations due to disability should contact the Disability Services Office at 503-491-6923 or
[email protected].
Dental Hygiene Program Associate of Applied Science Degree 2017
Helpful Hints: For questions about the admissions process, meet with the Dental Hygiene Admissions Evaluator during office hours starting in October. For current hours, visit: mhcc.edu/LRQA. Do not submit your application in double‐sided format. Double sided applications are more time consuming and difficult to process. Follow the directions carefully and ask questions if needed. All communication with applicants is done via email—always make sure the Admissions Evaluator has your current email address. The Admissions Evaluator will always use the email written on the applicant’s allied health admission form (even if you change it with the Admissions office) unless told otherwise. Make sure you add @MHCC.edu to your “safe senders” list. Do not submit this page or the front cover with your application.
Additional Resources:
For additional information about the program, please visit: mhcc.edu/DentalHygieneProgram Oregon Board of Dentistry: oregon.gov/dentistry American Dental Hygienists Association: adha.org American Dental Association: ada.org Commission on Dental Accreditation (CODA): ada.org
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Dental Hygiene Program Associate of Applied Science Degree 2017
APPLICATION PACKET CHECKLIST / Applicant Name
/ Date
(
) MHCC ID
Every item on this checklist needs to be submitted by the application deadline—December 22, 2016. Only completed applications containing all the required documents will be considered for review. You will not be given notification if items are missing. It is the applicant’s responsibility to make sure everything was received by the deadline. By signing below, I am confirming each item below is included with my application or I have confirmed they are already on file at MHCC. I understand it is my sole responsibility to submit the required documents, and I will not be given notice if my application is incomplete until after the deadline, at which time it will be too late to submit missing documents.
Item 1. Online General Admissions Form (https://my.mhcc.edu/ics/Admissions) ‐ select general studies as your major. It will change to Dental Hygiene if/when you are admitted into the program. Students who already have an ID number and who have attended within the last 4 terms can proceed to Step 2. 2. Application Packet Checklist—Page 3 3. Health Professions Division Application—Page 4 4. Prerequisite Course Planning Sheet—Page 5 5. Dental Hygiene Observation Form (SEALED) – Page 6 6. 2 Faculty Evaluation Forms (SEALED) – Page 7
7. $25 Application Fee—Make check payable to MHCC. Bank card/cash is only payable in person in Student Services (AC2253).
8. Official (in a sealed envelope) College Transcript(s) From EVERY COLLEGE EVER ATTENDED ( If up-to-date transcripts are on file showing most recently completed coursework with nothing in progress, do not submit another copy. Do not include MHCC transcript.)
9. Current Resume 10. Minimum Academic Documentation—Courses have to be completed with a “C” grade or higher. CPT scores are valid for 5 years, cannot be older than 12-22-2011. I have met the writing and math requirement by completing: Mathematics (choose one): Writing (choose one): MHCC College Placement Test MHCC College Placement Test Score Score with placement into MTH095 with placement into WR121
Placement Test Taken Outside of MHCC (list institution): _______________________
Completion of a MTH065 or higher with a "C" grade or better, completed no earlier than Winter 2010. *
* If math was taken prior to Winter term
Placement Test Taken Outside of 2010, applicants must demonstrate current MHCC (list institution): _______________________
knowledge through the CPT. If required placement level is not met, applicants must complete the required math course to Completion of a College‐Level reapply in the future. If required Writing Course (WR115 or higher placement level is met, applicant does not with “C” grade or better.) need to retake math.
1. MHCC’s Admissions, Registration and Records office will send all application notification by email. It is your responsibility to set your “spam filter” system to accept email addresses containing @mhcc.edu. Do this even if you are currently receiving emails from MHCC. We cannot be responsible for notices which are not received due to spam or junk mail handling. Make sure to add MHCC to your “safe senders list”. Applicants should check their email on a computer and NOT on a smart phone. 2. I understand it is my responsibility to ensure all items are received by the application deadline and that only complete applications will be evaluated for admission. Furthermore, I have read and understand the admission requirements and procedures for applying. I understand that withholding information or giving untruthful answers to questions on this application could be cause for non‐acceptance or dismissal from the program.
_______________________________________________________________ ________________________ Date
DENTAL HYGIENE – ALLIED HEALTH DIVISION APPLICATION Signature
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Dental Hygiene Program Associate of Applied Science Degree 2017
HEALTH PROFESSIONS DIVISION APPLICATION Please print and complete fully, do not leave blank. Attach extra paper if needed.
Name:
SSN or MHCC ID:
Previous Last Name(s):
Email: ALL notifications will go out via email to this address
Current Mailing Address: Street
Phone Number and Alternate Phone: (
City
)
State
(
Zip
)
Education Record: List ALL colleges attended. Omission of any college transcript may result in non‐admittance or dismissal from the program. Degree earned or approximate College: number of credits completed:
Previous Applications: List all Health Profession programs you have previously applied to. Program Title: Application year(s): College:
Were you accepted?
References: List two personal/professional references – non‐relatives Name: Address:
Phone:
Work Experience: In the grid below, list the position and the name of the company/organization. Note any certifications. Related: Unrelated: Volunteer*: *Only volunteer work dated 2013 to current will be considered
For Office Use Only Date Received:
Received By:
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Dental Hygiene Program Associate of Applied Science Degree 2017
PREREQUISITE COURSE PLANNING SHEET / Applicant Name
/
(
Date
) MHCC ID
Guidelines: For point assessment, only science courses completed by the end of Fall term 2016, completed within the last 7 years (no earlier than Winter 2010), with a “C” grade or higher will be used. No expire date on nutrition course. List non-MHCC courses as they appear on your transcript. Do not use the MHCC equivalency or convert to quarter credits. Accepted applicants must finish the full chemistry series, anatomy & physiology series, microbiology (labs included), math, and WR121 by the end of Spring 2017. Failure to complete any of these courses will result in revoking your acceptance. For repeated courses, list the better graded course; there will be a one point reduction each for repeating chemistry, biology and nutrition. Fill out each section in its entirety. No points will be awarded if the class is not fully documented below.
Dental Hygiene Prerequisites EXAMPLE
Course
Term/Year
Grade/Credit
Institution
BI234
WI/14
B/4
MHCC
Required Coursework: Must be completed by December 22, 2016 CH104* General, Organic and Biological Chemistry BI121* or BI231 Anatomy and Physiology 1 How have you met the Math requirement (5‐year expiration date for CPT. If math was taken prior to Winter 2010, applicants must demonstrate current knowledge through the CPT.)? List course in space provided. Completed MTH065 or higher: OR Placed into MTH095, not older than 12-22-2011: How have you met the Writing requirement (5‐year expiration date on CPT)?: List course in space provided. Completed WR115 (no expiration): OR Placed into WR121, not older than 12-22-2011: Supporting Coursework: Must be completed by end of Spring term 2017 – APPLICANTS, if you have not completed the courses below, please fill out this section with the expected term and year of completion. CH105 General, Organic and Biological Chemistry 2 CH106 General, Organic and Biological Chemistry 3 BI122 or BI232 Anatomy and Physiology 2 BI233 Anatomy and Physiology 3 (not needed if you are taking BI121/BI122)
BI234 Microbiology WR121 English Composition MTH065 Beginning Algebra II or higher Additional Coursework: Can be completed in, or prior to starting the program FN225 Nutrition PSY101/201/202/214/216 Psychology Elective SOC204/205/206 Sociology Elective SP100/111/115/218 Speech Elective WR122/123/227 English Composition: Research / Technical Report Writing *Or equivalent series
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Dental Hygiene Program Associate of Applied Science Degree 2017
DENTAL HYGIENE OBSERVATION FORM (REQUIRED) Applicant: To have a successful application, all applicants must have at minimum 20 hours of observation, 10 of which must be with a dental hygienist. We encourage applicants to seek a wide variety of settings to obtain their 20 hours. Please note, observation hours cannot be older than 1 year, and must be submitted with your application. We will not carry forward previous year’s observation hours. Fill out this form completely and have the Dental Office Supervisor complete and sign the necessary portions of this document. Have the dental facility put this form into an envelope and seal it. Please submit this with your application materials by the deadline, December 22, 2016 at 5 p.m. This form cannot be faxed. Dental Office Supervisor: Please fill out the information requested below and give this back to the applicant in a sealed envelope as part of their complete application. Please note an exact number of hours, do not put “N/A”.
From: Office:
Phone:
_______
Address: Applicant, please describe observation experience:
Name of applicant:
______ _________
Number of observation hours: ______________________ Office Representative and Title: Office Representative’s Signature:
_____________
Date:
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Dental Hygiene Program Associate of Applied Science Degree 2017
DENTAL HYGIENE PROGRAM –Applicant Evaluation Form Name of Program Applicant: __________________________________ Date: _____/______/_______ Faculty’s Discipline Area: ___________________________________ Applicant – you are required to submit 2 of these forms from two different faculty members of your choosing (not an adviser, dentist, classmate, etc…). Faculty member – you have been asked by a potential Dental Hygiene Program student to complete this evaluation form for the student’s application portfolio. This form is to be submitted as part of a completed application. Please give this completed form back to the student in a sealed envelope. Please be candid and honest; applicants to this program are usually academically sound and self‐motivated, but all have room for growth. Comments about an applicant’s strengths and areas for improvement are equally welcome and considered carefully. Please use the back side of this form if you need more room for comments. Your responses are completely confidential and will not be seen by the student who asked you to complete the form. Please do not share your responses with the student. They will be taken into consideration as a part of the application process, but are not the sole determining factor responsible for an applicant’s acceptance or non‐acceptance into the program. Your remarks and time are valuable, and appreciated in this important process. Thank you!
COMMUNICATION SKILLS (Place a check mark in the box that corresponds with your evaluation) Skill: Excellent Acceptable Needs growth No Basis to Evaluate Listens effectively Sensitive to others’ feelings, values, culture. Recognizes barriers to reaching a conclusion and participates in problem solving. Respectful of group differences evidenced by nonverbal/verbal communication. INTERPERSONAL DYNAMICS Skill: Able to manage emotions and behavior. Understands the concept of teamwork, courtesy and cooperation. Uses strategies for handling conflict; able to negotiate. PROBLEM‐SOLVING/THINKING SKILLS Skill: Learns concepts quickly. Organizes and applies information. Synthesizes information in meaningful ways. Assumes responsibility for personal performance in a group. Offers input/solutions that contribute to problem solving.
Excellent
Acceptable
Needs growth
No Basis to Evaluate
Excellent
Acceptable
Needs growth
No Basis to Evaluate
Comments?
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