(PDF) 2021 Collin College Dental Hygiene Program Admissions Packet Packet...1 2021 Collin College Dental Hygiene Program Admissions Packet Thank you for your interest in Collin College’s - DOKUMEN.TIPS (2023)

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    2022 Collin College Dental Hygiene Program

    Admissions Packet

    Thank you for your interest in Collin College’s Dental HygieneProgram. The enclosed packet provides information regardingadmission procedures, required courses, estimated expenses, theapplication, observation, and reference forms.

    The Associate of Applied Science degree in Dental Hygiene atCollin College is rated as

    an Exemplary Program in the State of Texas by the Texas HigherEducation

    Coordinating Board and has been awarded Accreditation with theAmerican Dental Association’s (ADA) Council on Dental Accreditation(CODA). Upon successful completion of the program, the student isawarded an Associate of Applied Science Degree and is eligible tosit for national and regional licensing examinations.

    Dental Hygiene is a two-year program that begins in the fallsemester of each year. Dental Hygiene classes are scheduled at theMcKinney Campus. Enrollment is limited and admission is competitivewith only 16 open positions per year. Admission to Collin Collegedoes not imply or guarantee admission to the Dental HygieneProgram. The program application deadline is 5:00 P.M. Thursday,January 13th 2022. However, applications to the program should besubmitted as soon as possible.

    This admissions packet has been designed to answer yourquestions regarding Dental Hygiene admission. Please read thepacket in its entirety, you may contact the Dental Hygiene Officewith further questions at (972) 548-6535 or Academic Advising at(972) 548-6782. Good luck with your application process!

    Christine McClellan, RDH, MSEd Dental Hygiene ProgramDirector

    Specific program requirements and program selection andacceptance criteria are subject to change at any time and withoutnotice. It is the

    applicant’s responsibility to keep informed of current programrequirements.

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    Dental Hygiene Career Description The dental hygienist is alicensed dental health care professional who specializes inperiodontal therapy and oral health education. A broad basededucation in biological sciences and humanities as well as dentalsciences and clinical techniques prepare the graduate for work inprivate practice and community settings. The dental hygienist is amember of the dental health team, along with the dentist, dentalassistant and dental laboratory technician. The dental hygienistmay be employed in private dental offices, dental product sales,public schools, or other institutions under the supervision of alicensed dentist. Alternative practice settings include hospitals,clinics, federal agencies and local and state health departments.The dental hygienist is in demand nationally, statewide andlocally, and opportunities are available on a full-time andpart-time basis for employment. Hygienists are also required tosatisfy 12 CE hours per year. In the state of Texas, the dentalhygienist is licensed to perform primary preventive proceduresincluding:

    • Perform oral health care assessments that include reviewingpatients’ health history, dental charting, oral cancer screening,and taking and recording blood pressure;

    • Expose, process, and interpret dental radiographs;

    • Remove plaque and calculus (soft and hard deposits) from aboveand below the gum


    • Apply cavity-preventive agents such as fluorides and sealantsto the teeth;

    • Teach patients proper oral hygiene techniques to maintainhealthy teeth and gums;

    • Counsel patients about plaque control and developingindividualized at-home oral

    hygiene programs

    • Counsel patients on the importance of good nutrition formaintaining optimal oral health.

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    Employment Opportunities

    *Working in a private dental office continues to be the primaryplace of employment for dental hygienists. For today’s dentalhygiene professional, there are many other career pathways toexplore as well. Never before has there been more opportunity forprofessional growth. How and where you work today is up to you. Letyour dental hygiene education and experience open doors to YOURcareer path and consider the possibilities.

    Dental hygienists in a clinical role assess, diagnose, plan,implement, evaluate and document treatment for prevention,intervention and control of oral diseases, while practicing incollaboration with other health professionals. Corporate dentalhygienists are employed by companies that support the oral healthindustry through the sale of products and services. Leadersthroughout the dental industry often employ dental hygienists dueto their clinical experience and understanding of dental practice.Community Health programs are typically funded by government ornonprofit organizations. These positions often offer an opportunityto provide care to those who otherwise would not have access todental care. Research conducted by dental hygienists can be eitherqualitative or quantitative. Quantitative research involvesconducting surveys & analyzing the results, while qualitativeresearch may involve testing a new procedure, product, or theoryfor accuracy or effectiveness. Dental Hygiene educators are ingreat demand. Colleges and universities throughout the U. S.require dental hygiene instructors who use educational theory andmethodology to educate competent oral health care professionals.Corporations also employ educators who provide continuing educationto licensed dental hygienists. Dental hygienists in administrativepositions apply organizational skills, communicate objectives,identify and manage resources, and evaluate and modify programs ofhealth, education and health care. By using imagination andcreativity to initiate or finance new commercial enterprises,dental hygienists have become successful entrepreneurs in a varietyof businesses.

    ** The median annual wage for dental hygienists was $74,820 inMay 2018. The median wage is the wage at which half the workers inan occupation earned more than that amount and half earned less.The lowest 10 percent earned less than $51,930, and the highest 10percent earned more than $101,820. Employment of dental hygienistsis projected to grow 11 percent from 2018 to 2028, much faster thanthe average for all occupations. The demand for dental serviceswill increase as the population ages. As the large baby-boompopulation ages and people keep more of their original teeth thandid previous generations, the need to maintain and treat teeth willcontinue to drive demand for dental care. Studies linking oralhealth and general health, and efforts to expand access to oralhygiene services, will continue to drive the demand for preventivedental services. As a result, the demand for all dental services,including those performed by hygienists, will increase. Inaddition, demand for dental hygienists is expected to grow as statelaws increasingly allow dental hygienists to work at the top oftheir training, and they effectively become more productive.

    *Source: American Dental Hygienists’ Association, on theInternet at https://www.adha.org/professional-roles (visitedOctober 17, 2019) **Source: Bureau of Labor Statistics, U.S.Department of Labor, Occupational Outlook Handbook, DentalHygienists, on the Internet athttps://www.bls.gov/ooh/healthcare/dental-hygienists.htm (visitedOctober 07, 2019).


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    Collin College Dental Hygiene Program Goals

    The Collin College Dental Hygiene Program will prepare thegraduate to perform clinical procedures, dental nutritionalcounseling, identify potential health problems and understand thephysical and clinical aspects of treatment. The student will studythe physical structures of the head, neck and teeth, recognizepatients’ health conditions, understand medications and theireffects and understand the disease process. The Dental HygieneProgram goals reflect the institution’s core values. They arelisted as follows:

    Create an active learning environment that integrates theprinciples of evidence-based research while promoting criticalthinking, self-evaluation, innovation, creativity, and lifelonglearning.

    Provide clinical experiences that promote a commitment tocommunity service and civic involvement while responding to theoral health needs of a diverse community.

    Provide students with the knowledge and clinical competencerequired to provide current, comprehensive dental hygiene servicesin a variety of settings for individuals of all ages and stages oflife including those with special needs.

    To treat each patient/client with dignity and respect.

    Create an environment that promotes the importance of wellnessin both student and patient/clients.

    To understand the relevance and integration of preventive dentalhygiene services in an evolving health care system.

    Collin College affirms as its mission the commitment to provide,within the resources

    available, educational programs and services that meet theindividual and community needs. The district seeks to promotelifelong individual growth and excellence through strengthening theintellect, character and capabilities of all students. The collegeacts as a resource to local, state, national and internationalcommunities by providing education, cultural and civic programs andservices.

    Collin College core values are as follows:

    Service and involvement Creativity and innovation

    Academic excellence Dignity and respect


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    Collin College Dental Hygiene Program

    Application Requirements

    Admission to the Dental Hygiene Program is very selective.Admission to the college does not guarantee admission to the DentalHygiene Program. The following items must be received by 5:00 P.M.Thursday, January 13th, 2022, in order to have a completedapplication that is eligible for review.

    Completed program application form

    Official copies of ALL college transcripts, including CollinCollege transcripts mailed directly to the Dental Hygiene ProgramDirector. Applicant is responsible for ordering all transcripts, asthe Dental Hygiene Department DOES NOT have access to obtain thisinformation for our applicants.

    Proof of completed prerequisite course requirements(transcripts) o Anatomy and Physiology I (BIOL 2401) o Anatomy andPhysiology II (BIOL 2402) o Introduction to Chemistry I (CHEM 1405)o Microbiology (BIOL 2420)

    Prerequisites must be completed within five years prior to theapplication deadline. Courses taken more than 5 years (no earlierthan Spring 2017) prior to the time of application deadline willnot be accepted. Please complete page 27 to help facilitate yourtranscript review. The applicant is responsible for ensuring theaccurate transfer of courses prior to submitting an application(See Academic Advising for assistance). Please note that the lackof prior approval will delay the processing of your application,and may affect your acceptance into the program

    Completed HESI exam All HESI exams must be taken between June 1and December 17, 2021, in order to apply by the applicationdeadline. THERE WILL BE NO EXCEPTIONS.

    Observation Hours-16 hours are required and must be completedwithin the last 12 months with a licensed dental hygienist.Observations completed with a DDS will not be considered. WAIVEDFOR 2022 APPLICATION CYCLE DUE TO COVID 19

    A TYPED 1-2 page essay that discusses why you have selectedCollin College Dental Hygiene.

    Two professional reference forms completed by an employer oreducator.

    Photograph of the applicant only (Size 4X6, does not have to bea professional photograph)

    It is recommended that you have tracking information on allmailed requirements to ensure delivery.

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    Collin College Admissions Requirements

    General transfer admissions requirements to Collin College:

    Complete an application online at https://apply.collin.edu.

    Official transcript from all regionally accredited institutionsof higher education.

    Provide proof of exemption/waiver of TSI.

    Provide proof of meningitis vaccination, if needed.

    Complete mandatory campus safety training.

    The Points System and Selection Criteria

    Admission into the Dental Hygiene program is extremelycompetitive, with 16 positions available per year. In order to makea fair and accurate decision, we utilize the following point systemto rank our applicants. Applicants will be ranked and selectedbased on the number of points earned. The Collin College DentalHygiene Program reserves the right to make changes to admissioncriteria and program information as circumstances require. In theevent of a tie for final slots into the program, qualifiedapplicants will be considered based upon their interviewpoints.

    1. Prerequisite Courses (Maximum of 16 points) Applicants can beawarded a maximum of 16 points for completion of the prerequisitecourses Anatomy and Physiology I, Anatomy and Physiology II,Introduction to Chemistry or General Chemistry and Microbiology.These courses must be completed within five years (no earlier thanSpring 2017) prior to the application deadline. Every applicant isresponsible for ensuring the accurate transfer of courses prior tosubmitting an application (See Academic Advising for assistance).Please note that the lack of prior approval will delay theprocessing of your application, and may affect your acceptance intothe program.

    If a course is four credit hours and has only one grade, thatgrade will apply for both the lecture and the lab. See additionalinformation below regarding honors course points.

    A in lecture course = 3 points A in lab = 1 point

    B in lecture course = 2 points B in lab = 1 point

    C in lecture course = 1 point C in lab = 0 points


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    2. HESI Exam (Maximum 15 points)

    (HESI may only be taken once per application year.)

    • Scores 90% and above will receive 3 points per category

    • Scores from 80-89% will receive 2 points per category

    • Scores 75-79% will receive 1 point per category

    The HESI is composed of a battery of tests that measuresabilities, skills, knowledge,

    and attitudes important for successful performance of studentsin the allied health

    education programs. The Dental Hygiene Program only considersscores from the following battery of five tests:

    • Anatomy and Physiology

    • Chemistry

    • Math

    • Reading Comprehension

    • Vocabulary and General Knowledge

    3. 16 Observation Hours (2 points)

    Applicants will be required to complete 16 hours of observing aRegistered Dental Hygienist. Hours must be within 12 months ofsubmitting application.

    4. Typed Essay (Maximum 3 points)

    All applicants must submit a typed, well-developed, 1-2 pageessay discussing why you have chosen to apply to the Collin CollegeDental Hygiene Program.

    5. Professional References (2 points) Two professional referenceforms are included in this packet and are to be completed byindividuals who can attest to

    your character and aptitude as a potential dental hygienestudent. Dental hygiene admission requires two completed referencesmailed directly by the person providing the reference to the DentalHygiene Program. References should be completed by an employer oreducator. If an employer or educator reference is not available,the reference must be from someone that has acted in a supervisoryposition.

    6. Honors Courses-BONUS points for BIOL 2401 AND/OR BIOL2402

    (Possibility of an additional 2 points if BIOL 2401 and BIOL2402 are taken at Collin College and a grade of “A” or “B” isearned)

    A in BIOL 2401 = 1 point A in BIOL 2402 = 1 point

    B in BIOL 2401 = 1 point B in BIOL 2402 = 1 point

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    Maximum Basic Requirement Points: 38 POINTS

    Maximum Honors Bonus Points: 2 POINTS

    Total Possible Application Points: 40 Points

    Interview (Maximum 5 points) Once all applications are receivedand reviewed, an invitation with the selection committee will beextended to a select few via phone. Invitation to the interviewdoes not guarantee acceptance into the Collin College DentalHygiene program.

    Each applicant will receive a score for their interview, whichwill be added to your overall application score. Not everyapplicant will receive an invitation for an interview. Please donot call or email to schedule an interview.

    Total Possible Application Points: 40 Points

    Maximum Interview Points: 5 Points

    Total Possible Admissions Points: 45 Points

    Applications are due by 5:00 PM Thursday, January 13th 2022, forconsideration of acceptance into the Fall 2022 entry class.Applicants will be notified by mail, within six to

    eight weeks after application deadline.

    Professionalism Statement: Professionalism is of the utmostimportance for our program. If an applicant displays unprofessionalbehavior at any time during the application process, theirapplication will be revoked immediately.

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    Additional Dental Hygiene Program Requirements

    Upon Formal Acceptance

    1. All student must be certified in CPR, the American HeartAssociation for the BLS for Healthcare Providers: Adult, Child andInfant with AED. CPR online courses will not be accepted.Completion of this requirement is mandatory prior to admittanceinto Preclinical Dental Hygiene (DHYG 1431). Certification must bemaintained through graduation and for licensure.

    2. The student will complete formal training in InfectionControl Procedures. No student will be allowed to deliver patientservices in any setting until he/she has been instructed on anannual basis in infection control (as per OSHA/ HIPAA guidelines,HB300 every 2 years) and has mastered material on safety/universalprecautions with satisfactory accuracy. Following mastery ofinfection control skills and under faculty supervision, eachstudent will be expected to provide services for patients withhealth deviations, including patients with HIV/HBV and otherbloodborne/infectious diseases, as part of routine clinical/labcurriculum experiences.

    3. The student must maintain a minimum overall GPA of 2.5 (75course average) once enrolled as a dental hygiene student.

    4. The student will be required to complete a drug screening andbackground check will Requirements for dental hygiene licensure asset by the Texas State Board of Dental Examiners (TSBDE) definethat individuals be “of good moral character”. All individualsaccepted into the program must meet licensure eligibilityrequirements. Information received from the background check ordrug screening may result in dismissal from the program. Inaddition to a drug screening following admissions, there may beadditional random or incident drug screenings while enrolled in thecurriculum.

    5. The student must be in good health and upon acceptance,furnish physical, dental and eye examination records. Forms will beprovided by the dental hygiene department, once accepted into theprogram.

    6. Annual TB testing is required by the dental hygienedepartment and clinical enrichment sites per OSHA guidelines.Dental hygiene students are required to show evidence of two skintests within the same year OR the results of a QFT, IGRA or T-spottest prior to the start of the second year.

    7. Annual influenza vaccine is required by the dental hygienedepartment and clinical enrichment sites per OSHA guidelines.

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    8. This section applies to all students enrolled inhealth-related courses, which will involve direct patient contactin medical or dental care facilities. This includes all medicalinterns, residents, fellows, nursing students, and others who arebeing trained in medical schools, hospitals, and health sciencecenters listed in the Texas Higher Education Coordinating Board’slist of higher education in Texas and students attending two-yearand four-year colleges whose course work involves direct patientcontact regardless of the number of courses taken, number of hourstaken, and the classification of the student. In addition, theState of Texas requires the applicant, upon formal acceptance, toprovide proof of the following immunization requirements:

    Students must have all of the following vaccinations before theymay engage in the course activities: (1) Tetanus-DiphtheriaVaccine: Students must show receipt of one dose of tetanus-diphtheria-pertussis vaccine (Tdap). In addition, one dose of atetanus-containing vaccine must have been received within the lastten years. Td vaccine is an acceptable substitute, if Tdap vaccineis medically contraindicated. (2) Measles, Mumps, and RubellaVaccines: (A) Students born on or after January 1, 1957, must show,prior to patient contact, acceptable evidence of vaccination of twodoses of a measles-containing vaccine administered since January 1,1968 (preferably MMR vaccine). (B) Students born on or afterJanuary 1, 1957, must show, prior to patient contact, acceptableevidence of vaccination of two doses of a mumps vaccine. (C)Students must show, prior to patient contact, acceptable evidenceof one dose of rubella vaccine. (3) Hepatitis B Vaccine: Studentsare required to receive a complete series of hepatitis B vaccine orshow serologic confirmation of immunity to hepatitis B virus priorto the start

    of direct patient care. This series may commence followingacceptance into the dental hygiene program, but a titer must becompleted and documentation of immunity (positive titer) must besubmitted to the dental hygiene department by December 1st of thefall semester of the first year, prior to providing direct patientcare. (4) Varicella Vaccine. Students are required to have receivedtwo doses of varicella (chickenpox) vaccine.

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    Limited Exceptions (1) Notwithstanding the other requirements inthis section, a student may be provisionally enrolled in thesecourses if the student has received at least one dose of eachspecified vaccine prior to enrollment and goes on to complete eachvaccination series as rapid as medically feasible in accordancewith the Centers for Disease Control and Prevention's RecommendedAdult Immunization Schedule as approved by the Advisory Committeeon Immunization Practices (ACIP). However, the provisionallyenrolled student may not participate in coursework activitiesinvolving the contact described in subsections (a) and/or (d) ofthis section until the full vaccination series has beenadministered. (2) Students, who claim to have had the completeseries of a required vaccination, but have not properly documentedthem, cannot participate in coursework activities involving thecontact described in subsections (a) and/or (d) of this sectionuntil such time as proper documentation has been submitted andaccepted.

    (3) The immunization requirements in subsections (b) and (d) ofthis section are not applicable to individuals who can properlydemonstrate proof of laboratory confirmation of immunity orlaboratory confirmation of disease. Vaccines for which this may bepotentially demonstrated, and acceptable methods for demonstration,are found in §97.65 of this title (relating to Exceptions toImmunization Requirements (Verification of Immunity/History ofIllness).

    Such a student cannot participate in coursework activitiesinvolving the contact described in subsection (a) of this sectionuntil such time as proper documentation has been submitted andaccepted.

    (b) Students may be provisionally enrolled for up to onesemester to allow students time to attend classes while obtainingthe required vaccines and

    acceptable evidence of vaccination.

    (c) Polio vaccine is not required. Students enrolled inhealth-related courses are encouraged to ascertain that they areimmune to poliomyelitis. (d) Students cannot be provisionallyenrolled without at least one dose of measles, mumps, and rubellavaccine if direct patient contact will occur during the provisionalenrollment period.

    (e) Students must show, prior to patient contact, acceptableevidence of vaccination of one dose of rubella vaccine.

    (f) Students born on or after January 1, 1957, must show, priorto patient contact, acceptable evidence of vaccination of one doseof mumps vaccine.

    (g) Students shall receive two doses of varicella vaccine unlessthe first dose was received prior to thirteen years of age.

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    Exceptions to Immunization Requirement

    (Verification of Immunity/History of Illness)

    (a) Serologic confirmations of immunity to measles, rubella,mumps, hepatitis A, hepatitis B, or varicella, are acceptable.Evidence of measles, rubella, mumps, hepatitis A, or hepatitis B,or varicella illnesses must consist of a laboratory report thatindicates either confirmation of immunity or infection.

    (b) A parent or physician validated history of varicella disease(chickenpox)

    or varicella immunity is acceptable in lieu of vaccine. Awritten statement from a physician, or the student’s parent orguardian, or school nurse, must support histories of varicelladisease.

    Source (modified): Title 25 Health Services, §§ 97.61-97.72 Ofthe Texas Administrative Code

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    Collin College Dental Hygiene Program Policy on BloodborneInfectious Diseases

    For Collin College Dental Hygiene Program Faculty/Staff,Applicants/Students and Patients Collin College is dedicated toproviding access to quality educational programs regardless ofdisability and within available resources. The College recognizesthe serious implications that the spread of communicable diseasehas on the health, safety and welfare of the student, faculty,staff, and general public. Therefore, the College is committed toensuring that each employee, applicant/student and patient beprovided with a safe and healthy environment. This communicabledisease policy is based on current, scientific, and medicalinformation. It is consistent with guidelines issued by the Centerfor Disease Control (CDC), Occupational Safety and HealthAdministration (OSHA) standards, and other national/state healthrelated organizations’ recommendations. Since scientificinformation is prone to frequent change, the Dental Hygiene Programwill update this policy annually, or as necessary, as newinformation on infectious diseases becomes available. Admission,Employment and Patient Treatment Persons who are seropositive forHIV/AIDS, HBV or other infectious diseases will not be excludedfrom employment, admissions, patient treatment or access to theinstitution’s services or facilities because of their healthstatus. They will be provided with all reasonable accommodationsunless a medically based evaluation determines that exclusion orrestriction is necessary for the welfare of the individual, othermembers of the institution, patients or affiliates (patient carecommunity). In the instances when a member of the college communityhas tested HIV positive or been diagnosed with AIDS, the Collegewill consider all obtainable facts, medical information and legaladvice in determining the appropriate course of action to take. Allsituations will be reviewed on a case-by-case basis considering anyrecent legislation or health reports. This policy has beendeveloped to provide a fair and equitable method of responding toAIDS within Collin College. All individuals with HIV/AIDS, HBV orother infectious diseases are expected to seek expert adviceconcerning their health circumstances and are obligated legally andethically to conduct themselves in a responsible and safe manner oncampus as a protection to the college community. The patientconsent form contains the following information: “I understand thatmy treatment in the Dental Hygiene Clinic at Collin College mayexpose students and employees to my blood and/or body fluids. Ifany student or employee is accidentally exposed to my blood/bodyfluids, I agree to undergo testing for blood pathogens (HepatitisB, HIV/AIDS). I also agree to have the testing agency report theresults of my test to the Dental Hygiene Director at CollinCollege. I realize that the College recognizes the importance ofconfidentiality and will only release my test results to thosepersons having need to know. I understand I must seek the servicesof an approved physician, for testing purposes and will beresponsible for all costs incurred from such services.”

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    Confidentiality/Disclosure The College recognizes the importanceof protecting the confidentiality and privacy of anyemployee/student found to have HIV/AIDS, HBV or other infectiousdisease. This information will be handled with care and sensitivityand will be kept confidential. The College also has aresponsibility to protect employees, students and patients from theharmful acts or conditions of its employees/students. Completeconfidentiality will be protected to the highest degree, howevermay not be guaranteed in such cases that would prevent responsibleactions. A personal physician, in keeping with the currentstandards, requirements and recommendations of the Centers forDisease Control (CDC) must routinely assess all students/employeeswho have a known infectious disease. An evaluation of theindividual will include the physician’s statement of theindividual’s susceptibility to infectious diseases oftenencountered when performing the objective/job skills required forthe individual’s curriculum. Communicable Disease StatementStudents who plan to enter the Collin Dental Hygiene Program willbe required to read and sign a communicable disease statement andwaiver of liability form. This form will become a part of thestudent’s permanent record and will state that the student:

    Has been informed of their risk for exposure to blood and bodyfluids.

    Understands the potential transmission of bloodborne diseaseduring patient care activities.

    Is financially responsible for any expenses incurred from thetesting/treatment following an occupational incident and/orcommunicable disease exposure.

    Agrees to treat all patients that are assigned regardless ofdisease state presented by the patient.

    Agrees to undergo testing following an occupational incident orneedle stick exposure to bloodborne pathogens.

    Must sign a declination form in the event a student refuses toundergo testing.

    Applicants/Students with Infectious Disease Applicants/studentswho believe they are at an increased risk of contracting aninfectious disease should seek testing and counseling prior tomaking application to the Dental Hygiene Program.Applicants/students who are HIV/AIDS, or HBV positive will not bebarred from working, teaching, attending classes or participatingin college sponsored activities unless the applicant/student isunable to follow Standard Precautions. All decisions will be madeon a case-by-case basis. Reporting Infectious Status Any student oremployee who knows, or has reasonable basis for believing that heor she is infected with HIV/AIDS, HBV, HCV or other infectiousdisease which may pose a threat to others, and whose curriculum orjob requires performance of patient care procedures which may proveexposed, has an obligation to share that information with ProgramDirector. Disclosure will allow the College to protect the welfareof employees, students and patients from the spread of disease, andwe can also respond appropriately to the individuals’ health andemployment/educational needs.

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    Students, faculty and staff of Collin College identified ashaving HIV/AIDS, HBV, or HCV will not be barred from working,teaching, attending classes or participating in college activitiesunless it is determined that he/she is unable or unwilling toconduct themselves in an ethical, responsible and safe manner oncampus. All decisions will be made on a case-by-case basis.Individuals in need of assistance will be referred to counselingservices. The individual will receive the college’s BloodbornePolicy and, if indicated, the AIDS in the Workplace brochure(https://www.cdc.gov/hiv/pdf/workplace/cdc-hiv-and-aids-and-the-workplace.pdf)that provides information regarding the availability of furtherassistance. Health Records for Students and Employees CollinCollege shall comply with any state and federal laws regarding theconfidentiality of educational and medical records of students andstaff. Health information about a student or employee is personaland confidential and should be treated as such. Records will bemaintained in a secure and confidential manner. HealthRequirement

    All students who plan to enter a health related field of studymust be able to prove immunity to mumps, measles, rubella, tetanus,diphtheria, polio and varicella zoster, hepatitis B andtuberculosis. Yearly TB testing must be done before students beginPre-Clinic and again before they begin their second year. TheHepatitis B vaccine must be started upon acceptance to the programwith the first injection. The second injection should be given atleast one month after the first dose, and the third injection sixmonths after the first dose. A titer needs to be performedfollowing the last series of Hepatitis B vaccine, as recommended byphysician.

    Additionally, second year students’ immunizations must becurrent and/or updated and copies on file before start of clinic.Provision of Care to Patients with Bloodborne InfectiousDisease

    Dental hygiene services will be provided to all persons in need.Decisions to provide dental hygiene care will not be made solely onthe fact that a person has a bloodborne infectious disease, is HIVseropositive or has AIDS. The skill and knowledge level of thestudent providers, experience of the student providers, equipmentavailable and concerns about compromise of the patient’s healthstatus will be taken into account in decision regarding care ofindividuals with bloodborne infectious disease. The student mustconsult with the patient’s physician to determine if the patient’shealth status would be significantly compromised by provision ofdental treatment.

    The patient who has active hepatitis should not be scheduled fordental hygiene care. A consult with the patient’s physician todetermine the patient’s status (non-infectious, infectious,carrier) must be performed prior to treatment. Standard precautionsshould be followed.

    Policy: All patients with HIV/AIDS are expected to seek expertadvice concerning their health circumstances and are obligatedlegally and ethically to conduct themselves in a responsible andsafe manner on campus as a protection to the college community.

    Procedure: Patients in the Dental Hygiene Clinic will be treatedfollowing Standard Precautions as outlined by the Center forDisease Control (CDC) guidelines.

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    It is the responsibility of Collin College’s dental hygieneprogram to make dental health care safe and effective for allpatients and to promote the highest standards of infection control.Acceptable means of protecting dental personnel from contractinginfectious diseases are available so that all types of treatmentcan be rendered in a manner that is safe for all patients andproviders.

    Patients with medical/dental needs beyond the scope available inthe dental hygiene clinic will be referred to the proper agency.Patients will be responsible for all cost incurred as a result ofreferral. No Collin College faculty or dental hygiene student mayethically refuse to treat a patient whose condition is within thedental hygienists’ realm of competence, solely because that patientis at risk of contracting, or has, an infectious disease such asHIV, AIDS or Hepatitis B infection. These patients must not besubjected to discrimination.

    Training in Infection Control Procedures

    No student will be allowed to deliver patient care in anysetting until he/she has been instructed in infection control (asper OSHA guidelines), and has mastered material on safety/standardprecautions with satisfactory accuracy. Students will be expectedto care for patients with health deviations including patients withHIV/AIDS, HBV, HCV, and other bloodborne infectious diseases aspart of routine clinical/laboratory curriculum experiences,following mastery of infection control skills and under facultysupervision.

    * The above policy “Dental Hygiene Department BloodbornePathogens Policy” will be distributed to clinical patients uponrequest. Airborne Pathogens OSHA regulations do not currentlyspecify specific employee protections from airborne pathogens inthe same manner as the Occupational Exposure to BloodbornePathogens Standard specifies protections against Bloodbornepathogens. Although the risk of transmission of tuberculosis indental settings is low, the Centers for Disease Control andPrevention (CDC) recommends dental health care personnel (DHCP)include protocols for TB infection control in their offices’written infection control program. Tuberculosis Tuberculosis (TB)is caused by infection with the bacterium Mycobacteriumtuberculosis. Infection occurs through inhalation of mycobacteria,which then travels to the alveoli of the lungs. In most people whobecome infected, the body is able to contain the bacteria andprevent it from multiplying. The bacterium can live in the lungs ofan infected person for years, even a lifetime, without the personexhibiting any symptoms. This state is called latent TB infection.A person with latent TB is not infectious to others but theinfection can develop into active TB disease in the future andusually exhibits a positive reactive tuberculin skin test. Mostpeople who have latent TB infection never develop active disease.Only people with active disease can spread the infection.

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    People with latent TB infection • have no symptoms • don’t feelsick • can’t spread TB to others • can have a positive tuberculinskin test reaction • can develop TB disease later in life if theydo not receive treatment for latent TB infection Most people whohave latent TB infection never develop active TB, but if they donot receive treatment for latent TB infection, about 10 percent oflatent TB infections can develop active disease over a lifetime.This can happen when the person’s immune system is weakenedallowing the bacteria to become active and cause TB disease (e.g.,individuals with HIV, diabetes, certain hematologic disorders suchas leukemias and lymphomas, prolonged corticosteroid use, and otherconditions). Only a person with active TB can transmit the disease.People with active TB disease • have symptoms (e.g., a productivecough, night sweats, fever, weakness or fatigue, weight loss,pain

    in the chest) • feel sick • can spread TB to others • can have apositive tuberculin skin test reaction The Centers for DiseaseControl and Prevention (CDC) has developed guidelines forpreventing transmission of Mycobacterium tuberculosis inhealth-care settings.1 Routine Medical History Ask all patientsabout past history of TB or exposure to TB. Ask about TB signs andsymptoms and medical conditions that increase their risk for TBdisease when taking their medical history. A diagnosis ofrespiratory TB should be considered for any patient with symptomsincluding coughing for more than 3 weeks, loss of appetite,unexplained weight loss, night sweats, bloody sputum or hemoptysis,hoarseness, fever, fatigue or chest pains. Dental Treatment and TBBecause a person with latent TB is not infectious, he or she can betreated in the dental office under standard infection controlprecautions.2 Any patient with symptoms suggestive of active TBdisease should be removed from the area of other patients or staff,instructed to wear a surgical or procedure mask, assessed for theurgency of their dental care and promptly referred for medicalcare. Standard precautions are insufficient to prevent transmissionof the bacterium. Elective dental treatment should be deferreduntil the patient has been declared non-infectious by a physician.Urgent dental care for a person with suspected or active TB shouldbe provided in a facility that has the capacity for airborneinfection isolation and has a respiratory protection program inplace. Reference:http://www.ada.org/en/member-center/oral-health-topics/tuberculosis-overview-and-dental-treatment-conside.For further information, “Tuberculosis Screening, Testing, andTreatment of U.S. Health Care Personnel: Recommendations from theNational Tuberculosis Controllers Association and CDC, 2019” can befound athttps://www.cdc.gov/mmwr/volumes/68/wr/mm6819a3.htm?s_cid=mm6819a3_w.


  • 18

    Functional Abilities / Core Performance Standards

    The Dental Hygiene Program complies with the American withDisabilities Act (ADA) and consistent with the ADA, the attachedFunctional Abilities/Core Performance Standards Worksheet providesthe framework to relate functional ability categories andrepresentative activities/attributes to any limitations/deficits infunctional abilities. These standards shall be used by the DentalHygiene Program in combination with the professional scope ofpractice, job analysis, other resources, and expert consultation tomake decisions related to the ability of the dental hygiene studentto perform the essential functions of dental hygiene.

    If a prospective student is unable to meet the required“Functional Abilities/Core Performance Standards,” the DentalHygiene Program in consultation with an advisor from theAccommodations at Collin College for Equal Support Services(ACCESS) Office will determine, on an individual basis, whether ornot reasonable accommodations can be made that would permit thestudent to meet these “Functional Abilities/Core PerformanceStandards” and thus, to continue in the program.

    Please note: “Skill/s tied to” under each of the sections is notintended to be a complete listing of skills but rather as anexample of a skill for which that ability is required. For acomplete listing of skills tied to that ability, please see theprogram director.

    Please Review the list of skills below. If you unable to meetthe standard/s even with correction (example: eyeglasses, hearingaids) on any of the items below, please list those on the lastpage.

    Instructions: Please carefully review the sixteen items andanswer the three questions at the end.

    1. Gross motor ability

    Move within confined spaces • Sit and maintain balance • Standand maintain balance • Reach above shoulders • Reach below waist 2.Fine motor ability

    • Pick up objects with hands • Grasp small objects with hands •Write clearly and neatly with pen or pencil • Type on a keyboard •Enter data using a key pad • Pinch/squeeze or pick up objects withfingers • Twist knobs with hands • Must have adequate manualdexterity as to be capable of maintaining sterility

  • 19

    3. Physical endurance

    • Stand at patient’s side during procedure

    • Sustain repetitive movement (example: chest compressions inCPR)

    • Maintain physical tolerance

    • Work and complete tasks at a reasonable pace

    • Walk/stand for prolonged periods of time

    4. Physical strength

    • Lift 25 pounds

    • Move light objects up to 10 pounds

    • Restrain combative patient with assistance

    • Carry equipment/supplies

    • Squeeze with hands (example: use of fire extinguisher)

    • Able to push/roll 60 pounds

    • Move heavy object weighing 10-50 pounds

    • Use upper body strength

    5. Mobility

    • Twist

    • Bend

    • Stoop/squat

    • Move quickly

    • Climb ladders/stairs/use stools

    • Walk

    6. Hearing (permissible to use hearing aids if they enablestudent to meet requirements listed


    • Hear normal speaking level sounds • Hear faint voices • Hearfaint body sounds (example: Breath and heart sounds • Hear auditoryalarms • Hear telephones • Hear sounds with stethoscope

  • 20

    7. Visual

    • Visually assess clients • See object up to 20 inches away •See object more than 20 feet away • Use peripheral vision •Distinguish color • Distinguish color intensity • See emergencylights/lamps 8. Tactile

    • Feel vibrations (example: pulses, fremitus) • Detecttemperature • Feel the difference in surface characteristics • Fellthe differences in sizes, shapes (example: palpate artery/vein) •Detect environmental temperature 9. Smell

    • Detect odor from patients • Detect smoke • Detect gas ornoxious smells 10. Reading

    • Read and interpret physician orders • Read and understandwritten documents • Read very fine or small print 11.Arithmetic

    • Read and understand columns of writing • Read digital displays• Read graphic printouts • Calibrate equipment • Convert numbers tometric • Read graphs (vital sign sheets) • Tell time • Measure time(duration) • Count rates (example: pulses, respiratory rate) • Usemeasuring tools (example: thermometer) • Read measurement marks(scales) • Able to perform basic arithmetic functions (add,subtract, multiply, divide) • Compute fractions • Use a calculator• Record numbers (example: chart observed parameters)

  • 21

    12. Emotional Stability

    • Establish therapeutic boundaries • Provide patients withappropriate emotional support • Adapt to changingenvironment/stress • Deal with the unexpected (example: crisis) •Focus attention on task despite distractions • Monitor own emotions• Perform multiple responsibilities concurrently • Handle strongemotions (example: grief) • Show appropriate compassion throughcommunications 13. Analytical Thinking

    • Transfer/extrapolate knowledge from one situation to another •Process information • Evaluate outcomes • Problem solve •Prioritize tasks • Use long and short term memory 14. CriticalThinking Skills

    • Identify cause-effect relationships • Plan/control activitiesfor others • Synthesize knowledge and skills • Sequence information15. Interpersonal Skills

    • Negotiate interpersonal conflict appropriately • Respectdifferences in clients • Establish rapport with clients • Establishrapport with co-workers • Work effectively with physicians, staff,patients and patients’ families 16. Communication Skills

    • Teach (example: patient and family) • Explain procedures •Give oral reports • Interact with others • Speak on the telephone •Direct activities of others • Convey information through writing(example: progress notes) • Convey information through date entry(electronic health record) • Speak clearly and distinctly

  • 22

    Please answer the following questions. Indicate if the questiondoes not apply.

    1. Please list any of the standards above that you feel that youmay not be able to meet even

    with correction (example: eye glasses or hearing aids). Use thereverse side if necessary.

    2. Do you have any limitations or problems that might posedifficulties for which you may need

    accommodations? If yes, please list. Use reverse side ifnecessary.

    3. For any items listed in the two questions above pleasecontact the ACCESS Office at Collin

    College (972.881.5898).

    ACCESS (Accommodations at Collin College for Equal SupportServices) is a comprehensive

    accommodation program for all Collin College students.Reasonable accommodations for

    students with documented disabilities are provided. Studentswith disabilities are encouraged to

    make an appointment with an ACCESS advisor as soon as possiblein order for the program to

    prepare reasonable accommodations that may exist. Thereasonableness of the accommodation

    will be assessed by a program committee.




  • 23

    Health Education Systems, Inc.

    Admission Assessment

    HESI Exam: The HESI A2 Exam is used to test academic readinessof those who are wishing to enter the Dental Hygiene program atCollin College. It consists of the following topics: Anatomy andPhysiology, Chemistry, Math, Reading Comprehension, and Vocabularyand General Knowledge. The test will be given in a proctoredat-home format using your personal computer. The test will beadministered by ProctorU and the cost is $60. Click on the linkbelow or copy it into a web browser to be taken to the registrationsite. https://www.proctoru.com/portal/elsevier-hesi A study guideentitled: HESI Admission Assessment Exam Review (Edition 5) may bepurchased through Elsevier or Amazon.


  • 24

    Pre Entrance Requirements Lec Lab Ext Cont Credit

    BIOL 2401 Anatomy and Physiology I 1 3 4 0 112 4

    BIOL 2402 Anatomy and Physiology II 1 3 4 0 112 4

    BIOL 2420 Microbiology for Non-Science Majors 3 4 0 112 4

    CHEM 1405 Introduction to Chemistry I 3 4 0 112 4

    TOTAL HOURS 12 16 0 448 16 FIRST YEAR

    First Semester Lec Lab Ext Cont Credit

    DHYG 1201 Orofacial Anatomy, Histology and Embryology

    1 3 0 64 2

    DHYG 1304 Dental Radiology 2 3 0 80 3

    DHYG 1431 Preclinical Dental Hygiene 2 8 0 160 4

    ENGL 1301 Composition I 3 1 0 64 3

    SPCH 1311 Introduction to Speech Communication 3 0 0 48 3

    TOTAL HOURS 11 15 0 416 15 Second Semester Lec Lab Ext ContCredit

    DHYG 1207 General and Dental Nutrition 2 0 0 32 2

    DHYG 1219 Dental Materials 1 2 0 48 2

    DHYG 1227 Preventive Dental Hygiene Care 2 1 0 48 2

    DHYG 1235 Pharmacology for the Dental Hygienist 2 0 0 32 2

    DHYG 1261 Clinical I - Dental Hygienist 0 0 8 128 2

    PSYC 2301 General Psychology 1 3 0 0 48 3

    TOTAL HOURS 10 3 8 336 13 SECOND YEAR First Semester Lec Lab ExtCont Credit

    DHYG 1211 Periodontology 2 0 0 32 2

    DHYG 1215 Community Dentistry 1 4 0 80 2

    DHYG 1239 General and Oral Pathology 2 1 0 48 2

    DHYG 2153 Dental Hygiene Practice 1 0 0 16 1

    DHYG 2201 Dental Hygiene Care I 2 0 0 32 2

    DHYG 2361 Clinical II - Dental Hygienist 0 0 18 288 3

    TOTAL HOURS 8 5 18 496 12 Second Semester Lec Lab Ext ContCredit

    DHYG 2102 Applied Community Dentistry 0 3 0 48 1

    DHYG 2231 Dental Hygiene Care II (Capstone) 2 1 0 48 2

    DHYG 2363 Clinical III - Dental Hygienist 0 0 18 288 3

    GEN ED Select one Humanities / Fine Arts General Educationcourse

    2-3 0-3 0 48-80 3

    SOCI 1301 Introduction to Sociology 3 0 0 48 3

    TOTAL HOURS 7-8 4-7 18 480- 512 12

    GRAND TOTAL 48-49 43-46 44 2176-2208 68

    Collin College Associate of Applied Science Dental HygieneDegree


  • 25

    Collin College Dental Hygiene Program Estimated Costs

    All of the costs listed in the bulletin are estimates andsubject to change

    *Lab fees are not included. ** $200 minimum required by lawTuition and Fees

    * $54.00/ credit hour

    *$100.00/ credit hour **$202 credit hour**

    In County Out of County Out of State

    First Year Estimated Expenses

    Second Year Estimated Expenses




    Shoes and Uniforms



    Immunizations/ Hepatitis Vaccine

    Approximately $200.00 +

    TB/ Flu

    Annual requirements

    Record Keeping Fee for Immunizations




    $4,520.00 + Tax

    $360.00 + Tax

    Dental Hygiene Student Prof. Association Dues

    $65.00 (Fall)

    $65.00 (Fall) Liability Insurance

    $11.00 per year

    $11.00 per year 2 Cap and Gown Fee


    $40.00 Graduation Photographs


    $25.00 (Fall) National Board Review Seminar National Board Exam(Written)


    $425.00 (Fall/optional)

    $440.00 (Late Fall) Regional Board Exam (Clinical)


    $1500 (Early Spring) CPR/ AED Certification


    $60.00 (depending on renewal)

    Drug Screening



    Background Check



    Jurisprudence Exam


    $54.00 (Fall)

  • 26


    Collin College Dental Hygiene Program

    2022 Admissions Packet Checklist

    Applicant Name__________________________________________________

    Application Form

    Official Transcripts BIOL 2401 BIOL 2402 CHEM 1405 BIOL 2420

    (Addressed to ATTN: Director of Dental Hygiene)

    Prerequisite Course Requirements/Grades Earned Form

    PSB Exam

    16 Observation Hours Form

    Typed 1-2 Page Essay

    2 Reference Forms

    Photograph 4X6

    *Have all Official College Transcripts (no copies accepted)mailed or transmitted electronically to:

    Collin College Department of Dental Hygiene, Suite A119 Attn:Director of Dental Hygiene 2200 W. University Dr. McKinney TX,75071

    Be sure to send OFFICIAL TRANSCRIPTS* from ALL Institutions,INCLUDING COLLIN TRANSCRIPTS. *NOTE: 2 sets of transcripts will beneeded; send 1 to the Director of Dental Hygiene and 1 toAdmissions and Records Office. Electronic transcripts areacceptable if received directly from the college or transcriptclearinghouse. Please call 972-548-6535 for instructions on howthey should be addressed. If you are already enrolled at CollinCollege, you do not need to send a Collin College transcript to theAdmissions and Records Office.








  • 27

    Dental Hygiene Prerequisite Course Requirements & GradesEarned



    Email Address:______________________________________________________________________

    Prerequisite Course Number Grade Semester/Year Taken


    Anatomy and Physiology I

    Anatomy and Physiology II

    Introduction to Chemistry


    Please submit this form along with your application. Allrequired prerequisites must be completed within five years prior tothe application deadline, or no earlier than Spring of 2017.Courses taken more than 5 years prior to the time of applicationdeadline will not be accepted. Every applicant is responsible forensuring the accurate transfer of courses prior to submitting anapplication (See Academic Advising for assistance or call972-548-6778 or 972-548-6779.) Please note that the lack of priorapproval will delay the processing of your application, and mayaffect your acceptance into the program.

  • 28

    COLLIN COLLEGE DENTAL HYGIENE PROGRAM APPLICATION Associate ofApplied Science Degree in Dental Hygiene

    Social Security # _______-_______-_______ Name:________________________________________________________________________Last First MI Other Names Known By Address:________________________________________________________________________Street City State/Zip Code Telephone: ( __)___________________________________ Cell(____)_______________________ Email Address:________________________________________________________________________

    College/University Attended Credit Hours (Including CollinCollege) Major/Minor Dates Attended Completed

    Degree earned and college awarding the degree:


    Have you previously applied to this program? If so, please statethe application year: ________

    Have you ever been convicted of or plead guilty to a felony ordo you have a criminal charge pending?

    Y or N If yes, give the year, location and nature of theviolation and disposition: __________________________


    I have read the Functional Abilities/Core Performance Standardsfor Dental Hygiene as listed in this packet.____________Initials

    Signature Date

    My signature certifies that all information given on thisapplication is true, complete and accurate. (Applications will notbe considered without a signature.)

    RETURN THIS COMPLETED FORM TO: Director of Dental Hygiene

    2200 W. University Drive, Suite A119, McKinney, Texas 75071

  • 29

    Collin College Dental Hygiene Program Registered DentalHygienist Observation Verification Form

    Name of Applicant:_________________________________________________________Applicant’s Phone Number:


    Instructions: Observation hours will need to be observed througha registered dental hygienist only. After completing theobservation form, it must be placed in a stamped and addressedenvelope (provided by the applicant), and mailed directly to us bythe dental hygienist that was observed. If the applicant hasobserved more than one hygienist, multiple forms may be received.Before mailing, the hygienist’s signature must be written acrossthe flap. DO NOT GIVE THE FORM TO THE APPLICANT FOR MAILING.Envelopes must be received by the Collin College Dental HygieneDepartment by Thursday, January 13, 2022, by 5:00P.M. LATE FORMSWILL NOT BE ACCEPTED, NO EXCEPTIONS. (Tracking your items isrecommended)

    Date Observation Location Office Name and

    Telephone Number

    Name of Dental Hygienist

    Signature and License Number

    Number of Hours Observed

    Total Hours

    A minimum of 16 observation hours are required PLEASE MAIL FORMTO: Collin College Director, Dental Hygiene 2200 W. UniversityDrive, Suite A119 McKinney, TX 75071

  • 30

    Collin College Dental Hygiene Program Professional ReferenceForm

    The following person is using your name as a professionalreference for application to the Collin College Dental HygieneProgram. The applicant must have this evaluation in his/her file inorder to be considered for admission to the Dental Hygiene Program.We appreciate you taking time to complete the followingquestionnaire. This form must be received by 5:00 P.M. Thursday,January 13th, 2022. Please send form directly to: Collin CollegeDirector, Dental Hygiene Program 2200 W. University, Suite A119McKinney, Texas 75071

    Applicant’s Name:_____________________________________________________________________

    Please check your responses:

    In what capacity do you know the applicant? ___Employer___Educator

    How long have you known the applicant? ___3 years

    Rate the applicant in the following areas:

    Communication Skills:

    ___Unable to assess

    ___Occasionally uses poor grammar in verbal and writtencommunication

    ___Frequently uses poor grammar in verbal and writtencommunication

    ___Always uses proper grammar in verbal and writtencommunication

    ___Usually uses proper grammar in verbal and writtencommunication



    ___Unable to assess

    ___Frequently absent or late, calls in

    ___ Frequently absent or late, rarely calls in

    ___Occasionally absent or late, always calls

    ___Never absent or late


  • 31

    Applicant’s name:_____________________________________________________________________Neatness/Grooming: *hygiene includes external environmental odors___Unable to assess

    ___Consistently displays poor hygiene and/or grooming

    ___Occasionally displays poor hygiene and/or grooming

    ___Usually neat and well-groomed

    ___Always neat and well-groomed


    Interpersonal Skills:

    ___Unable to assess

    ___Displays difficulty getting along with others

    ___Makes an attempt to get along with others, but is easilyangered or swayed

    ___Gets along with others most of the time

    ___Always gets along with others



    ___Unable to assess

    ___Disorganized; does not complete tasks

    ___Occasionally disorganized, but still completes tasks

    ___Well-organized in work habit; independently productive


  • 32

    Applicant’s name:_____________________________________________________________________


    ___Unable to assess

    ___Relies on direction for all actions

    ___Occasionally needs direction; occasionally initiates ownactivities

    ___Seldom needs direction; frequently initiates ownactivities

    ___Self-motivated; seeks opportunities to gain new knowledge andasks appropriate questions


    If you are a dentist, would you employ this individual once alicensed dental hygienist?




    Additional Comments:

    Signature: ___________________________________________Date:____________________________

    Printed Name:_________________________________________________________________________



  • 33

    Collin College Dental Hygiene Program Professional ReferenceForm

    The following person is using your name as a professionalreference for application to the Collin College Dental HygieneProgram. The applicant must have this evaluation in his/her file inorder to be considered for admission to the Dental Hygiene Program.We appreciate you taking time to complete the followingquestionnaire. This form must be received by 5:00 P.M. Thursday,January 13th, 2022. Please send form directly to: Collin CollegeDirector, Dental Hygiene Program 2200 W. University, Suite A119McKinney, Texas 75071

    Applicants Name:______________________________________________________________________

    Please check your responses:

    In what capacity do you know the applicant? ___Employer___Educator

    How long have you known the applicant? ___3 years

    Rate the applicant in the following areas:

    Communication Skills:

    ___Unable to assess

    ___Occasionally uses poor grammar in verbal and writtencommunication

    ___Frequently uses poor grammar in verbal and writtencommunication

    ___Always uses proper grammar in verbal and writtencommunication

    ___Usually uses proper grammar in verbal and writtencommunication



    ___Unable to assess

    ___Frequently absent or late, calls in

    ___ Frequently absent or late, rarely calls in

    ___Occasionally absent or late, always calls

    ___Never absent or late


  • 34

    Applicant’s name:_____________________________________________________________________

    Neatness/Grooming: *hygiene includes external environmentalodors

    ___Unable to assess

    ___Consistently displays poor hygiene and/or grooming

    ___Occasionally displays poor hygiene and/or grooming

    ___Usually neat and well-groomed

    ___Always neat and well-groomed


    Interpersonal Skills:

    ___Unable to assess

    ___Displays difficulty getting along with others

    ___Makes an attempt to get along with others, but is easilyangered or swayed

    ___Gets along with others most of the time

    ___Always gets along with others



    ___Unable to assess

    ___Disorganized; does not complete tasks

    ___Occasionally disorganized, but still completes tasks

    ___Well-organized in work habit; independently productive


  • 35

    Applicant’s name:_____________________________________________________________________


    ___Unable to assess

    ___Relies on direction for all actions

    ___Occasionally needs direction; occasionally initiates ownactivities

    ___Seldom needs direction; frequently initiates ownactivities

    ___Self-motivated; seeks opportunities to gain new knowledge andasks appropriate questions


    If you are a dentist, would you employ this individual once alicensed dental hygienist?




    Additional Comments:

    Signature: ___________________________________________Date:____________________________

    Printed Name:_________________________________________________________________________



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