MINIMUM APPLICATION CRITERIA

Florence Darlington Technical College Expanded Duty Dental Assisting Program Application and Selection Criteria Rev. 2/16 MINIMUM APPLICATION CRITERIA for the Dental Assisting Program. Applicants must have a high school diploma or GED, admission to Florence Darlington Technical College and at a minimum have completed the following courses to be eligible for consideration for admission to the program. High School Biology with a grade of C or better MAT Placement score Algebra 44 Typing/Computer Compass (Reading-61; Writhing-61) Attendance at Career Talk within one year of the application date of the program Applicants with previously completed college credit or degree must have official transcript sent to Registrar s office. 2.0 GPA must be maintained in all prerequisite and co-requisite courses prior to applying to Dental Assisting program. MINIMUM SELECTION CRITERIA for the Dental Assisting Program. Students are advised that should there be a greater number of applicants than positions available: Florence, Darlington and Marion County residents and/or students completing the majority of the required Dental Assisting Program credit hours (prerequisites and co-requisites) at FDTC are given preference in the selection process when all other requirements have been met. The number of program courses completed at FDTC PROOF OF RESIDENCE Residents of South Carolina, as defined by state law, are independent or dependent persons who have domiciled in South Carolina for a period of no less than 12 months. Further proof of residency is required for the Allied Health Program Students, who do not reside in the Florence, Darlington or Marion Counties and have not taken the majority of the programs course work at FDTC. A driver s license will be accepted for proof of residency if it is at least 12 months old.. 1

Expanded Duty Dental Assisting Entrance Requirement Map College Admission Admission to the College Submit transcipts from colleges previously attended Complete college admission placement testing for enrollment in the appropriate Math and English courses Program Entrance Requirements Attend a DAT Career Talk information session within one year of application (Career Talk dates are posted on www.fdtc.edu under Allied Health) Must maintain a 2.0 GPA State on Application to FDTC the Expanded Duty Dental Assisting Program Apply to Program Admission to Program After acceptance to the DAT program, please complete the forms found on the program website Complete the following forms found on Program Website Medical Physical including Hep B series or titer Background check with Certifiedbackground.com Urine Drug Screen CPR for Health Care Provider 2

Dental Assisting Program Memo to Students February 22, 2016 TO: FROM: RE: Expanded Duty Dental Assisting Applicants Kathy Dickson, Dental Program Director Florence-Darlington Technical College Application Process and Other Information Applicants are to be advised that due to specific requirements for National Board examination and state licensing, background checks and drug screenings are part of the admission and retention process. The background check will be completed once the applicant has been accepted to the program. Applicants with specific conviction histories or positive drug screenings may ultimately not be accepted into the Expanded Dental Assisting Program. Positive background checks will be sent to the LLR state licensing agency without identifying information, for their decision to allow the applicant to participate in the clinical examination. The applicant cannot be admitted to the program due to the inability to participate in the State Board exams. Specific convictions or positive drug screens occurring after full admission and matriculation in the program will be addressed per department policy, including dismissal. Students are advised that should there be a greater number of applicants than positions available: Florence, Darlington and Marion County residents and/or students completing the majority of the required Expanded Dental Assisting Program credit hours (prerequisites and co-requisites) at FDTC are given preference in selection process when all other requirements have been met. I would like to thank you for your interest in the Dental Assisting Program and for choosing Florence-Darlington Technical College to meet your professional educational requirements. 3

Dental Assisting Program Application Checklist Name: Student ID#: The following are minimum requirements or necessary steps for consideration for admission to the Expanded Dental Assisting Program. Complete each step/requirement and certify by initialing on this form that the step/requirement has been met. Submit this form during your dental assisting advising session. Each item must be initialed by the applicant indicating the requirement has been met: Admission as a credit diploma seeking student to Florence-Darlington Technical College. High School diploma or GED is on file with the Registrar. College transcripts of all transfer credits are on file with the Registrar. Overall cumulative credit grade point average of 2.0 or higher has been earned. A minimum GPA of 2.0 must be maintained in all prerequisite and co-requisite courses prior to applying to the DAT Program, as a C or better is required in all Expanded Duty Dental Assisting courses and in all General Education courses. Attendance at a Career Talk information session within one year of application to the program Prerequisite and General Education Program Support Courses Please write in an E if you are enrolled, the grade earned if the course has been completed, and an NE if you are not enrolled nor has the course been previously completed. Completion of a prerequisite course in progress at the time of application must be completed with a grade of C or better for final acceptance and enrollment. HS BIO HS typing PSY 103 ENG 155 MAT 155 High School biology or BIO 100 C or better HS typing/computers AOT 100 or CPT 170 with a C or better Human Relation Communications I Contemporary Mathematics I have completed all of the above requirements. Student s Signature: Date: 4

Expanded Duty Dental Assisting Program Application PLEASE PRINT CLEARLY AND PROVIDE THE INFORMATION REQUESTED IN ALL SECTIONS. INCOMPLETE APPLICATIONS CANNOT BE CONSIDERED IN THE SELECTION PROCESS. Name: (Last) (First) (Middle) Any Former Names: Student ID Number: Home Mailing Address:** **Note: If mailing address is PO Box, you must also provide a physical address. City: County: State: ZIP Code: Home Telephone Number: ( ) Work or Cell (specify): ( ) FDTC E-mail Address: The applicant can expect the application for Dental Assisting National Boards to include the questions below. If any of the questions below can be answered yes by the applicant, the applicant is advised to contact Kathy Dickson at 843-676-8514 for an appointment with the Dental Program Director to review Dental Assisting National rules and regulations regarding certification. This appointment must be made prior to the application to the Dental Assisting Program. 1. Have you ever been convicted, pled guilty, or nolo contendere for violation of any federal, state, or local law, or do you have charges pending (other than a minor traffic violation)? 2. Have you ever had any investigation, formal complaint, disciplinary action, or consent order filed against you by any person, hospital, or dental board committee in any jurisdiction? 3. Have you ever received disciplinary action by an employer for your job performance? 4. Have you developed any disease or condition, physical, mental, or emotional that might interfere with your ability to competently and safely perform the essential functions of practice as a dental assistant? DO NOT WRITE IN THIS SPACE. TO BE COMPLETED (IF NECESSARY) BY THE DENTAL PROGRAM DIRECTOR. I have counseled the above identified applicant regarding the certification/licensing process in the State of South Carolina in relation to previous criminal convictions. Dental Program Director Florence-Darlington Technical College Date 5

State Board of Dental Examiners (http://llr.state.sc.us) Dentist, Dental Hygienist Practice Act: 40-15-190. Grounds for disciple of dentist, dental hygienist, or dental technician (A) Misconduct which constitutes grounds for revocation, suspension, probation, reprimand, or other restriction of a license or certificate or a limitation or other discipline of a dentist, dental hygienist, or dental technician occurs when the holder of a license or certificate: (1) has made a false, fraudulent, or gorged statement or document or committed a fraudulent, deceitful, or dishonest act in connection with a licensure or registration requirement. (2)has been convicted of a felony or other crime involving moral turpitude or controlled substances; forfeiture of bond or a plea of nolo contender is equivalent to a conviction; (3) is unable to practice dentistry or dental hygiene or to perform dental technological work with reasonable skill and safety to patients by reason of physical illness or disability, mental illness, or the illness of alcoholism or substance abuse; (4) has employed or permitted and unlicensed or unregistered person to practice dentist or dental hygiene or to perform dental technological work except as permitted under this chapter; (5) has published, circulated, or made public in any manner, directly or indirectly, a false, fraudulent, deceptive, or misleading statement as to the skill or methods or practice of a dentist, dental hygienist, or dental technician; (6) has instructed, advised, or required a patient to deal directly with an organization or individual performing dental technological work; (7) has failed to provide and maintain reasonable sanitary facilities or conditions; (8) has failed to provide adequate radiation safeguards; (9)has violated the principles of ethics in the practice of dentistry as promulgated in the regulations of the State Board of Dentistry; (10) has practiced fraud or deceit in the practice of dentistry or dental hygiene or in the performance of any dental technological work; (11) has represented the care being rendered to a patient or the performance of dental technological work or the fees being charged for providing the care or work in a false or misleading manner; (12) has used a false, fraudulent, deceptive, or misleading statement in a document including, but not limited to, claims for reimbursement from third parties connected with the practice of dentistry, dental hygiene, or dental technological work; (13) has obtained a fee which is charged or a reimbursement from third parties or assisted in obtaining the fees or reimbursement through dishonesty or under false or fraudulent circumstances; (14) has failed to meet the standards of care in the practice of dentistry or dental hygiene or the performance of dental technological work; (15) has violated any provision of this chapter regulating the practice of dentistry, dental hygiene or the performance of dental technological work; (16) has committed and act which would constitute battery upon a patient; (17) has solicited or accepted dental technological work directly from the general public (18) has engaged in fraud, deceit, or misrepresentation in dealings with licensed dentists; (19) has dispensed, prescribed, administered, or obtained drugs for any use in any regimen other than one appropriate for the practice of dentistry. I certify that I have read and understand the above standards that apply to dental assistants in the State of South Carolina. Applicant Signature Date 6

***NOTE: Admissions will be based on the information included on this application, and on transcripts available. Information received after admission decisions are made cannot be considered for the current application period. Florence-Darlington Technical College is an equal opportunity institution and Florence-Darlington Technical College does not discriminate on the basis of race, color, religion, national or ethnic origin, creed, marital status, veteran status, disability, sex, or age in its admission policies, programs, activities or employment practices. Florence-Darlington Technical College Dental Assisting Program Certification and Authorization to Investigate CERTIFICATION AND AUTHORIZATION TO INVESTIGATE I hereby certify that the facts set forth in the above application are true and complete to the best of my knowledge, and I understand that discovery of the falsification of this information will result in my being denied admission and/or my prompt dismissal from the Dental Assisting Program. The Florence-Darlington Technical College Dental Assisting Department is hereby authorized to make any investigation concerning information that is deemed necessary by the Department to determine my suitability to practice as a dental assistant during the selection process, and/or during my tenure as a student, if admitted to the Dental Assisting Program. Applicant Signature Date 7