2017-2019 PCC Dental Hygiene Program Application Instructions Page 1 Thank you for your interest in the (PCC) Dental Hygiene Program. PCC s Dental Hygiene Program is a competitive, closed entry program. APPLICATION DEADLINE: APRIL 17, 2017 at 5:00 p.m. All application materials must be submitted to the Health Admissions Office, SY CC 208, by this deadline. Materials postmarked but not received by the deadline will NOT be accepted. If submitting your application within two weeks of the application deadline, hand delivery of your application materials is the only way to guarantee receipt by the 5:00 p.m. application deadline. Due to PCC centralized mail distribution process, expedited mailing options are not directly received by the Health Admissions Office on the delivery confirmation date. Application materials may not be faxed, e-mailed, or scanned. Minimum application requirements for the program beginning Fall 2017 Course completion deadline: All required prerequisite courses must be complete by the end of the winter term prior to the application deadline. Grade requirements: Individual prerequisite courses must be taken for a letter grade and must be completed with a grade of C or higher. Timeline for Fall 2017 Admission Early December Applications are available online at www.pcc.edudh January 1 through April 17, 2017 at 5:00 p.m. Applications are accepted. April 17, 2017 at 5:00 p.m. APPLICATION DEADLINE This is NOT a postmark deadline. We do not accept faxed or emailed applications or materials. Mailed applications must be received in the Health Admissions Office by the 5 p.m. deadline on April 17, 2017. Early May Applicants notified by PCC email of invitation to proctored essay. Mid-May Proctored essay takes place at Sylvania campus. Mid-June Applicants informed of their admission status via PCC email address. Summer Admitted and Alternate applicants attend Orientation. Students offered placement in the program must meet the post-selection requirements before final admission status is complete. Fall Term -- Dental Hygiene Program begins. The Dental Hygiene Program consists of 7 consecutive quarters. Official Transcript Policy A transcript is a copy of a student's permanent academic record from a college or university including all courses taken, all grades received, and all degrees and certificates conferred to a student. Official transcripts are issued directly from a college or university s registrar. Official transcripts are required from all colleges or universities where courses were attempted and must be in a sealed envelope from the institution where work was completed. Official transcripts must be submitted with your dental hygiene program application by 5:00 p.m. on April 17, 2017. Other PCC departments, including Student Records, will not be able to accept official transcripts required for the dental hygiene application, even if previously submitted for transfer credit evaluation. For Organic Chemistry courses not taken at PCC, a copy of the course syllabus is required to be included with your application. Policy for Receiving Points for Shadowing or Employment in a Dental Setting and Dental Assisting Students For job shadowing points (20 hours minimum), the Dental Experience Form B included in the application packet must be filled out completely and signed by the dental hygienist or dentist and included with these application materials. For those employed in a dental setting for a minimum of one year, or a CODA certified Dental Assistant, or a Dental Assisting student, the Dental Experience Form A included in the application packet must be filled out completely and signed by the dental instructor or dentist and included with these application materials. This is the instruction page; do not submit with your application.
For office use only Payment type: Check # Money Order # Business office receipt 2017-2019 PCC Dental Hygiene Program Application Page 1 Please check here if you applied to PCC s Dental Hygiene Program in 2016. (PCC keeps all application materials on file for one year. Re-applicants do not need to resubmit official transcripts unless they took additional courses) Please check if you were you an Alternate for PCC s Dental Hygiene Program: 2016 2015 2014 Student Information Please type or print neatly in blue or black ink Last Name First Name Middle Initial Previous Last Name(s) PCC Student ID# Date of Birth (mmddyyyy) Current mailing address number and street City State Zip Message Phone Alternate Phone EMAIL NOTICE: PCC will only use email to communicate notification of admission status. PCC will only email correspondence regarding your admission status to a PCC email address. If you do not regularly use your PCC email address, please forward your PCC email address to one you check regularly. I have read and understand the email notice. Education Information Below, please list ALL institutions of higher education attended. Students applying to the dental hygiene program MUST submit official, sealed transcripts (other than PCC transcripts) WITH their program application to the Health Admissions Office, even if previously submitted to PCC. Transcripts submitted to the Health Admissions Office separate from the application WILL NOT be accepted. Application materials submitted to the Health Admissions Office after April 17, 2017 at 5:00 p.m. will not be considered and will render your application ineligible. Other PCC departments, including Student Records, will not be able to accept Dental Hygiene Application transcripts. For office use only CollegeUniversity State Dates of attendance Degree earned Please note that all required application documentation must be received by 5:00pm April 17, 2017. Late applications with an April 17 th postmark will not be considered. If submitting your application within two weeks of the deadline, hand delivery of your application materials is the only way to guarantee receipt by the 5 pm deadline. Due to PCC centralized mail distribution process, expedited mailing options are not directly received by the Health Admissions Office on the delivery confirmation date. All transcripts and application materials must be hand-delivered or mailed to: Health Admissions Office SY, CC 208
2017-2019 PCC Dental Hygiene Program Application Page 2 Prerequisite Completion Chart Please complete the following course completion chart and submit with your program application PREREQUISITE COURSES Courses Completed Course Quarter or SCIENCE COURSES: number Semester? EXAMPLE: PCC BI 231 Quarter Fall 08 A 4 BI 231: Anatomy & Physiology I BI 232: Anatomy & Physiology II BI 234: Microbiology (within 7 years) CH 106 OR CH 102: Organic Chemistry Course Quarter or number Semester? MTH 65 or higher: Introduction to Algebra-2 nd term MATHEMATICS: ENGLISH COMPOSITION : Course number Quarter or Semester? WR 121 or higher: English Composition I GENERAL EDUCATION COURSES: Course Psychology Elective: (recommended course PSY 101) Sociology Elective: (recommended course SOC 204) Communications Elective: (recommended course COMM 100 or COMM 111) OPTIONAL FOR APPLICATION: Food & Nutrition (FN 225) Supplemental Essay Question Quarter or semester? Please include a typed response to the following: Please list special skills, experience, or education that will enable you to be successful in this program. Describe how you have benefited from these or other activities or volunteerism. Application Checklist Please complete and enclose the following items: PCC Admissions Application Apply as a degree seeking student online at www.pcc.eduadmissions. You do not have to complete a new PCC application if you are already admitted, but make certain all addresses and phone numbers on file are current. I have read and understand the Degree Outcomes for a Dental Hygienist http:www.pcc.eduprogramsdental-hygieneoutcomes.html I have completed and signed Dental Hygiene Program Application and prerequisite completion chart. I have included the $25 Application Fee (cash not accepted: checks or money orders should be made out to PCC). I have included the supplemental essay question response, one page typed (include name and student ID number at the top of the page). I have included the official college transcripts, from all institutions attended and Organic Chemistry syllabus (other than PCC). Dental Experience Form A: EmployerDental Instructor (must be completely filled out & signed for points), & Copy of CDA certificate if applicable, OR Dental Experience Form B: Shadowing Hours (must be completely filled out & signed for points). I have read & understand the admission criteria for the Dental Hygiene program. I understand that it is my responsibility to meet all program & application criteria. I verify that all statements on this application are complete & true. I understand that falsification of any information may lead to disqualification or dismissal from the program. Signature Date
2017-2019 PCC Dental Hygiene Program Page 3 Dental Experience Form A DENTAL EMPLOYER or DENTAL ASSISTING INSTRUCTOR Applicant name: Student ID#: We ask that the dentist or dental assisting instructor who has worked with the applicant be the person to complete this recommendation. Points WILL NOT be awarded unless this form is filled out COMPLETELY. To be completed by the DENTAL EMPLOYER Length of Employment: In what capacity has this applicant been employed in your office: Front office Chair side dental assistant Sterilization assistant or rover Hygiene assistant Other: To be completed by the DENTAL ASSISTING INSTRUCTOR College: Graduation date: To be completed by the Dental Assisting Instructor OR Dental Employer Using the rubric below, please give an honest appraisal of the applicant in each of the following categories: Below Average (50%) Average (50-75%) Good (75-90%) Outstanding (90-98%) Exceptional (Top 2%) Not Observed or Not Applicable 1 2 3 4 5 N Intellectual Ability 1 2 3 4 5 N Written Communication 1 2 3 4 5 N Verbal Communication 1 2 3 4 5 N Ability to understand and follow verbal instructions 1 2 3 4 5 N Potential for Clinical Competence 1 2 3 4 5 N AmbitionMotivation 1 2 3 4 5 N ResponsibilityConscientiousness 1 2 3 4 5 N Integrity 1 2 3 4 5 N Interpersonal Skills 1 2 3 4 5 N Multicultural Sensitivity 1 2 3 4 5 N This form MUST be received in the Health Admissions Office by 5:00pm on April 17, 2017 in order for this to be considered in the applicant s completed application packet. Postmarked recommendations will not be considered. Once complete, please enclose this form in one of your business or institution envelopes. You may give the signed, sealed envelope to the applicant to submit with their application, or you may mail this form to: Health Admissions Office SY, CC 208 EmployerDA Instructor Name Signature Date Title Phone Number
2017-2019 PCC Dental Hygiene Program Application Page 4 Dental Experience Form B Dental Hygiene Shadowing Hours Applicant name: Student ID: (Applicant, fill out above) To be completed by the dental hygienist who the applicant shadows. Once complete, please enclose this form in one of your business or institution envelopes and seal the envelope. Name of Dental Office Address Phone Number Shadow Dates Shadow Times Total Shadow Hours Completed This form MUST be received in the Health Admissions Office by 5:00 pm on April 17, 2017 in order for this to be considered in the applicant s completed application. Postmarked forms are not considered. You may give the signed, sealed envelope to the applicant to submit with their application, or you may mail this form to: Health Admissions Office SY CC 208 Hygienist s Name Signature Date