San Juan College Dental Hygiene Program. Application 2016

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1 San Juan College Dental Hygiene Program Application 2016 Name of Applicant: For Department Use Only: Date Received: By: Signature 1

2 Welcome The San Juan College Dental Hygiene Program is a selective program and admission is limited. Students seeking to enter must complete the following application and all required steps prior to the deadline of April 7, We look forward to receiving your application! If you have any questions regarding the application process, please do not hesitate to contact us: Dental Program Phone: (505) / Fax (505) Please take a moment and tell us how you heard about the SJC Dental Hygiene Program. Internet Search Word of Mouth Dentist/Hygienist Brochure Advisor Other: 2

3 Guidelines Please utilize the following guidelines to ensure that you have completed all of the required steps necessary for applying to the San Juan College Dental Hygiene Program. If you have previously applied to the SJC Dental Hygiene Program and would like to reapply, you are required to fill out a new SJC Dental Hygiene Program application. Before you apply, please make sure you meet all of the minimum eligibility requirements listed in the SJC Academic Catalog and also listed on our website at; If you have not done so already, you must contact the SJC Dental Hygiene Program to set up an appointment with our Program Advisor to conduct a review of your eligibility. Before you apply to the SJC Dental Hygiene Program, you must apply to and be accepted to San Juan College. o This is not the same as applying to and being accepted to the SJC Dental Hygiene Program. By applying to San Juan College, we can properly determine which of the prerequisite and general education courses you have taken will transfer. This is the first step, and without it, we cannot determine the eligibility of courses you have taken. o To apply to San Juan College, go to (Online application is FREE. Paper application is $10.00). When you apply to San Juan College, please be sure to mark Pre-Dental Hygiene as your major.) Send all official transcripts to the San Juan College Office of Admissions. (Not directly to the SJC Dental Hygiene Program). o This process may take 3-4 weeks. Please be sure to have your transcripts sent in well ahead of the application deadline! o You may request to have your transcripts sent electronically. Please have them ed directly to the San Juan College Office of Admissions at Complete all of your Prerequisite and General Education Courses. o You may have courses in progress at the time you apply to the SJC Dental Hygiene Program. All of the prerequisite courses must either be completed or in progress at the time of the SJC Dental Hygiene Program application, and must be completed prior to entering the SJC Dental Hygiene Program. Utilize the In Progress Grade Report Form to have your Professors report your in progress grades. These should be sent directly to the SJC Dental Hygiene Program. Please have your ACT scores sent directly to San Juan College Office of Admissions and include a copy of your ACT scores with your application by the application deadline. Deadline: Thursday, April 7, 2016 at 5:00pm. Please submit all pages of your completed application to: San Juan College Dental Hygiene Program 4601 College Blvd. Farmington, NM

4 Section A Personal Information LAST M.I. FIRST 1) Name of Applicant 2) San Juan College ID # STREET NAME & NUMBER APT. # CITY STATE ZIP CODE 3) Physical Address STREET NAME & NUMBER APT. # CITY STATE ZIP CODE 4) Mailing Address 5) Address 6) Home Phone Number ( ) 7) Work Phone Number ( ) 8) Cell Phone Number ( ) Are you a New Mexico Resident? Yes No Are you a resident of any one of the following Colorado counties? Yes No (Montezuma, Archuleta, Dolores or San Juan) Students meeting the residency and/or special residency status as defined in the San Juan College Academic Catalog will be given a 5% Residency Preference on their application. Have you ever been convicted of a felony? Yes No Individuals who have been convicted of a felony may have limited employment opportunities in the dental field. 4

5 Section B Educational Institutions Please list all Educational Institutions, High School and above, and Health Related Programs you have attended in the order you attended them. 1) Name of Institution: Address: Phone Number: Health Related Program: Yes No Degree(s) and/or Certificate(s) Accomplished: 2) Name of Institution: Address: Phone Number: Health Related Program: Yes No Degree(s) and/or Certificate(s) Accomplished: 3) Name of Institution: Address: Phone Number: Health Related Program: Yes No Degree(s) and/or Certificate(s) Accomplished: 4) Name of Institution: Address: Phone Number: Health Related Program: Yes No Degree(s) and/or Certificate(s) Accomplished: Have you ever been dismissed from a professional program or academically withdrawn from a profession program? Yes No If yes, complete the following information: School Name and Location: Dates of Attendance: to Type of Program: Are you in good standing and eligible to return to the program? Yes No If no, please explain: 5

6 Section C Educational Courses Please fill out the Prerequisite Courses you have completed in the chart below. Send all official transcripts to San Juan College Office of Admissions. (Not directly to the SJC Dental Hygiene Program). This process may take 3-4 weeks. Please be sure to have your transcripts sent in well ahead of the application deadline! You may request to have your transcripts sent electronically. Please have them ed directly to the San Juan College Office of Admissions at PREREQUISITE COURSES Introductory Biology I BIOL 121* Course ID (eg BIOL 121) Course Title Final Grade Date Completed Course Status C = Completed I = In Progress NT = Not Taken Institution Where Course Was Taken Human Anatomy & Physiology I BIOL 252* Human Anatomy & Physiology II BIOL 253* Microbiology BIOL 224* Introductory Chemistry OR Higher CHEM 110* Math for Health Careers OR Higher MATH 114 Freshman Composition ENGL 111 6

7 Section C Educational Courses Continued Please fill out the General Education Courses you have completed in the chart below. Send all official transcripts to San Juan College Office of Admissions. (Not directly to the SJC Dental Hygiene Program). This process may take 3-4 weeks. Please be sure to have your transcripts sent in well ahead of the application deadline! You may request to have your transcripts sent electronically. Please have them ed directly to the San Juan College Office of Admissions at GENERAL EDUCATION COURSES Introduction to Sociology SOCIO 110 Course ID (eg BIOL 121) Course Title Final Grade Date Completed Course Status C = Completed I = In Progress NT = Not Taken Institution Where Course Was Taken Introduction to Psychology PSYC 120 Public Speaking SPCH 110 OR Interpersonal Comm. SPCH 111 Advanced Composition ENGL 211 OR Adv. Tech. Composition ENGL 218 Introduction to Nutrition HLTH 118 In Progress Courses: If you currently have courses in progress at the time of application, please have your Professor complete the attached form and mail it directly to the SJC Dental Hygiene Program. Please use one form for each instructor. You may copy this form as necessary. Please include the Course ID, Section Number, Course Title, and the Number of Credits. 7

8 In Progress Grade Report Form Dear Professor, Your student is applying for the SJC Dental Hygiene Program and has asked you to forward their in progress grade in your course as part of the Application Process. Please fill out the form below and mail this letter directly to the SJC Dental Hygiene Program by April 7, Please include the Course ID, Section Number, Course Title, and the Number of Credits. Thank you very much for your assistance. (Student Name) is currently enrolled in (Course ID and Section #, Example: ENGL ) (Course Title, Example: Freshman Composition) (# of Credits, Example: 3) at (Name of Institution) His/Her current grade is: Instructor s Name: Instructor s Signature: Date: Please mail to: San Juan College Dental Hygiene Department 4601 College Blvd. Farmington, NM

9 Section D Previous Dental Experience Please list work experiences related to Dental Health Care. Employment verification letters must be attached to the application. Job Title Employer s Name, Address & Phone Number Dates of Employment Hrs/wk worked Name Month/Year to Month/Year Street City State Zip Code Phone List Job Responsibilities Job Title Employer s Name, Address & Phone Number Dates of Employment Hrs/wk worked Name Month/Year to Month/Year Street City State Zip Code Phone List Job Responsibilities Job Title Employer s Name, Address & Phone Number Dates of Employment Hrs/wk worked Name Month/Year to Month/Year Street City State Zip Code Phone List Job Responsibilities 9

10 Section E Observation Hours Please observe 3 dental hygienists, 4 hours each, at 3 different dental offices. Please ask the hygienists the following questions and record their responses. Please dress in professional attire and closed shoes. If you have previously applied to the SJC Dental Hygiene Program, you do not need to resubmit your observation hours. Applicant s Name Affix Dental Office Business Card Here Name of Dental Office Date of Observation Name of Dental Hygienist Applicant Observed 1) What is the best part of your job? Applicant-Observe and Record 2) What is the worst part of your job? 3) What is your average daily routine? 4) Notes: Dental Hygienists Notes 10

11 Section E Observation Hours Please observe 3 dental hygienists, 4 hours each, at 3 different dental offices. Please ask the hygienists the following questions and record their responses. Please dress in professional attire and closed shoes. If you have previously applied to the SJC Dental Hygiene Program, you do not need to resubmit your observation hours. Applicant s Name Affix Dental Office Business Card Here Name of Dental Office Date of Observation Name of Dental Hygienist Applicant Observed 1) What is the best part of your job? Applicant-Observe and Record 2) What is the worst part of your job? 3) What is your average daily routine? 4) Notes: Dental Hygienists Notes 11

12 Section E Observation Hours Please observe 3 dental hygienists, 4 hours each, at 3 different dental offices. Please ask the hygienists the following questions and record their responses. Please dress in professional attire and closed shoes. If you have previously applied to the SJC Dental Hygiene Program, you do not need to resubmit your observation hours. Applicant s Name Affix Dental Office Business Card Here Name of Dental Office Date of Observation Name of Dental Hygienist Applicant Observed 1) What is the best part of your job? Applicant-Observe and Record 2) What is the worst part of your job? 3) What is your average daily routine? 4) Notes: Dental Hygienists Notes 12

13 Section F Essays Please complete each of the 3 essay questions. Each essay must be a maximum of 500 words, double spaced, and typed in 12 point font. Place your San Juan College ID number and the question number only at the top right of each essay page as identifiers. (Example: , Question #1). Each essay will be evaluated, on an anonymous basis, by faculty from the San Juan College Humanities Department. Essays are evaluated based on; Critical Thinking Ethical Decision Making Writing Skill o Organization of Content o Vocabulary and Sentence Fluency o Elaboration of Ideas Question #1 Have you ever struggled for something and failed? How did you respond? Have you experienced a feeling of disappointment and dissatisfaction of yourself? Question #2 Evaluate a significant experience, risk you have taken, or ethical dilemma you have faced and its impact on you. Question #3 Write about a book that has special significance for you and explain why. 13

14 Section G: The ACT Please have your ACT scores sent directly to San Juan College Office of Admissions and include a copy of your ACT scores with your application by the application deadline. The ACT Registration o Online registration is the fastest method. You will know immediately if your preferred test center has space for you to test, and you can print your admission ticket from the website. Register online at Test Center in Farmington, NM o San Juan College, Code: o Testing Centers outside of Farmington, NM are available. For more information please visit ACT Scores o Please have your ACT scores sent directly to San Juan College Office of Admissions and include a copy of your ACT scores with your application. o The San Juan College code is: ACT Fee o ACT (No Writing): $39.50 Includes reports for you and up to four college choices (if valid codes are provided when you register). All fees are nonrefundable unless otherwise noted. Additional registration fees may apply. Please visit for more information. Retake the ACT Test o Students can take the ACT up to 12 times total. Expiration Date on ACT Scores o The Dental Hygiene Program will accept ACT Scores, regardless of date taken. Test Dates at San Juan College Test Date Registration Deadline Late Fee Required October 24, 2015 September 18, 2015 September 19-October 2, 2015 December 12, 2015 November 6, 2015 November 7-20, 2015 February 6, 2016 January 8, 2016 January 9-15, 2016 April 9, 2016 March 4, 2016 March 5-18, 2016 June 11, 2016 May 6, 2016 May 7-20, 2016 *Test dates are on Saturday unless otherwise noted. **SPECIAL NOTE: Non-Saturday testing is available only for student who cannot test on a Saturday because of religious convictions. If there is a non-saturday test center within 75 miles of your home for any test date, register for that date and request that center. For more information please visit or call (319)

15 Section H - Acknowledgement I have read and understand what is required for the SJC Dental Hygiene Program application process. I know to contact the SJC Dental Hygiene Program, if I have any questions about applying. I understand the deadline for this application process is Thursday, April 7, 2016 at 5:00 p.m. I understand that if required information is not included with my application for the SJC Dental Hygiene Program my application will not be considered. I understand that admission to the SJC Dental Hygiene Program is competitive and that applicants are assessed and ranked. The SJC Dental Hygiene Program requires students to do a criminal background check. Acceptance into the SJC Dental Hygiene Program is conditional upon a Certified Background Investigation following selection. The ability to participate in required off-sight clinical activities and to obtain a professional license may be dependent upon a criminal background check. Race/Ethnicity (optional) The Program gathers race/ethnicity data for information purposes only and to meet accreditation standards for access and equity. Answering the race/ethnicity question is optional and in no way affects your application. White, Non-Hispanic Black, Non-Hispanic Hispanic American Indian or Alaskan Native Asian or Pacific Islander Unknown Race/Ethnicity Other: I certify this application to be true and correct and that I am solely responsible for my answers. By signing below, I give San Juan College permission to conduct a criminal background check. Any false statements knowingly submitted will result in my being removed from consideration for acceptance into the Program and is grounds for dismissal from the Program. Printed Full Name Signature Date MAKE AND KEEP A COPY OF THIS APPLICATION FORM FOR YOUR RECORDS. 15

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