Eastern Washington University Dental Hygiene Application Instruction Sheet & Checklist for 2016 Admissions for Fall 2016 INSTRUCTIONS AND CHECKLIST:

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1 Eastern Washington University Dental Hygiene Application Instruction Sheet & Checklist for 2016 Admissions for Fall 2016 INSTRUCTIONS AND CHECKLIST: 1. Contact an Advisor. To schedule an in person or over the phone advising appointment, please call or your questions to 2. Apply to Eastern Washington University early in December. Submit official transcripts with the most current fall quarter/semester of college or university coursework. Pay the $50.00 application fee. Transfer students apply: Returning students apply: 3. Complete the Dental Hygiene Program application. Dental Hygiene applications will be accepted beginning January 5 th, 2016 and will have a deadline of February 15 th, 2016 at 5:00 p.m. Incomplete applications or applications received after the deadline will not be considered. All applications in the 2016 cycle are being evaluated for admission to the dental hygiene class that begins in the fall of Confirm application is complete. Application has been signed. Official, sealed transcripts from ALL colleges / universities attended are included (or noted that they will be sent separately). Documentation of observation hours or volunteer hours or dental office employment included. NOTE: EWU transcripts do not need to be sent. 5. Mail completed application via Certified U.S. Mail to: Eastern Washington University Department of Dental Hygiene 310 N. Riverpoint Blvd. Box E Spokane, WA Pay the $42.00 Dental Hygiene application fee through your account in EagleNET. a. Login to EagleNET: b. Select Student Account c. Click on Pay my Bill d. Select term, click on submit e. At the bottom, click on Make A Payment f. At the top, click on Pay my Bill or Optional Charges g. Click on Applications h. Select Dental Hygiene App Fee Spokane Campus and click on Add to Shopping i. Checkout and pay. This fee is non refundable

2 7. the receipt from the $42.00 application fee to Leila at: Upon receipt of this , instructions for completing the Health Science Reasoning Test will be sent to you. 8. Take the Health Science Reasoning Test (HSRT). Deadline for completing the HSRT is February 10 th, Applicants who attended out of state colleges/universities for dental hygiene prerequisite coursework are strongly advised to submit their dental hygiene application packets (including college catalog(s) from out of state institutions) by January 15. Applications will be accepted beginning January 5 th, The final deadline for 2016 admission applications is February 15 th, Accepted students in the 2016 admissions cycle will begin in the fall of Revised 9/2015 2

3 APPLICATION FOR ADMISSION TO THE DENTAL HYGIENE PROGRAM COLLEGE OF HEALTH SCIENCE AND PUBLIC HEALTH EASTERN WASHINGTON UNIVERSITY This application will be reviewed and evaluated by the EWU dental hygiene admissions committee. Please type or print neatly, and answer all questions completely and accurately. The dental hygiene program application and official transcripts must be sent via certified mail to: Eastern Washington University, Department of Dental Hygiene, 310 N Riverpoint Blvd. Box E, Spokane, WA Hand delivered applications will not be accepted. The deadline for application is 5 P.M, February 15 th, This application must be received by the dental hygiene admissions committee by the above date. GENERAL INFORMATION Date of application EWU Student ID Number (required) Legal Name Former Name (if applicable) Nickname (if applicable) Current mailing address Street City State Zip Permanent address (if different) Street City State Zip Current phone number Other phone number (if applicable) address: When did you formally apply to EWU? (month & year) Your current EWU acceptance status is: accepted pending not accepted Have you been dismissed from a dental hygiene program in the U.S.? Yes No If yes, which program 3

4 COLLEGE OR OTHER POST HIGH SCHOOL INSTITUTION ATTENDED OR NOW ATTENDING: Complete name of transferable associate degree (including option ), if applicable. Name of College Location (City / State) Dates of Attendance Official Name of Degree Rec d or Expected Date degree was or will be awarded WORK EXPERIENCE (Non Dental Office Experience): Position description Dates Employer name address phone # Position description Dates Employer name address phone # Position description Dates Employer name address phone # 4

5 One of the following three options is required for applicant eligibility. 1. DENTAL OFFICE EMPLOYMENT VERIFICATION: (3 months minimum of paid employment, full or half time) EMPLOYMENT VERIFICATION: INCLUSIVE DATES OF EMPLOYMENT: EMPLOYER S NAME: ADDRESS: CITY: STATE: ZIP: PHONE: JOB DESCRIPTION: EMPLOYER S SIGNATURE: 2. DENTAL OFFICE VOLUNTEER EXPERIENCE VERIFICATION: (20 hours minimum of volunteer work, in 1 2 separate dental settings) TOTAL HOURS AT SETTING #1: SUPERVISOR S NAME AT SETTING #1: ADDRESS: CITY: STATE: ZIP: PHONE: VOLUNTEER ACTIVITIES: SUPERVISOR S SIGNATURE: TOTAL HOURS AT SETTING #2: SUPERVISOR S NAME AT SETTING #2: ADDRESS: CITY: STATE: ZIP: PHONE: VOLUNTEER ACTIVITIES: SUPERVISOR S SIGNATURE: NOTE: The employers listed above may be contacted for verification. 5

6 3. OBSERVATION OF DENTAL HYGIENISTS IN PRACTICE: The dental hygiene department admissions committee requires that each student applicant without significant dental office work or volunteer experience in dental settings (see sections 1 & 2 above for descriptions) observe dental hygienists in practice. Observing dentists in practice, while a worthwhile activity, does not meet this requirement. Applicants with significant dental office work or volunteer experience in dental settings (offices or clinics) are not required to meet this requirement. The observation experience (for applicants without experience) must be a minimum of 20 hours in one or more settings (offices or clinics). We encourage applicants (whether they have significant dental backgrounds or not) to observe for 1 3 hours at the EWU dental hygiene clinic, if possible. An appointment should be made with the front office staff during fall or early winter quarters (509) Professional dress is requested. DATE OF VISIT NO. OF HOURS ACTIVITIES OBSERVED HYGIENIST S SIGNATURE, OFFICE ADDRESS, AND PHONE# NOTE: The hygienists listed above may be contacted for verification. 6

7 PREREQUISITE COMPLETION: Please list the courses that you are currently taking or plan to take to complete general education and pre dental hygiene requirements during your final year of prerequisite coursework. If your school is on the semester system, please indicate below: Winter Quarter Semester (year) Name of School: Official dept. names, course numbers course title, credits: (e.g., ENGL 101, 5 cr.) Spring Quarter Semester (year) Name of School: Official dept. names, course numbers course title, credits: (e.g., ENGL 101, 5 cr.) Summer Term (year) Name of School: Official dept. names, course numbers course title, credits: (e.g., ENGL 101, 5 cr.) 7

8 DENTAL HYGIENE ADMISSIONS COURSE WORK CHECKLIST Instructions: This checklist will be verified and reviewed by the admissions committee. Please provide all information neatly and accurately. All sciences must have been taken with 5 years of the date of application. 1. COURSES COMPLETED OR IN PROGRESS NOW: Course Name REQ and Number English Composition (e.g.: ENGL101) Qtr/Sem completed or in progress Name of College Or University Course Grade Intro to Psychology (e.g.: PSYC100) ONLY 1 SCIENCE REPEAT IS ALLOWED. If any sciences have, please indicate which course you want considered. Inorganic or General Chemistry (e.g.: CHEM161) Organic Chemistry (e.g.: CHEM162) Anat & Phys I (e.g.: BIOL232) (e.g.: BIOL&160 if at CC) Anat & Phys II (or equiv) (e.g.: BIOL233) Nutrition (e.g.: FNDT356) 2. COURSES COMPLETED OR PLANNED SOON: Course Name REQ and Number Anat & Phys III (or equiv) (eg: BIOL234) Qtr/Sem completed or in progress Name of College Or University Course Grade Microbiology (e.g.: BIOL 235) Biochemistry (eg: CHEM163) Interpersonal Communication (NOT public speaking) I certify the information submitted in this application is complete and accurate to the best of my knowledge. I grant the department of dental hygiene permission, if necessary, to request additional information from previous schools concerning my academic and conduct record. I understand that failure to complete all EWU General Education Core Requirements, Math, English, Computer Literacy, International Studies, Culture & Gender Diversity, and dental hygiene prerequisites prior to the fall 2016 entry into the program will result in my acceptance being rescinded. Signature: Date: Print Name: 8