Valencia College Health Sciences Program Application Associate in Science Degree in Dental Hygiene

Valencia College Health Sciences Program Application Associate in Science Degree in Dental Hygiene For admission consideration, you must submit this application with any required documentation and have all of your grades posted to your Valencia transcript by the January 15 th application deadline. All admission decisions will be sent to your Valencia ATLAS EMAIL from HealthScienceApplications@valenciacollege.edu approximately 5-7 weeks after the application deadline. Admission decisions will NOT be sent via postal mail. Date of Application: For Summer entry VID# (Required) Name (Last) (First) (Middle) Phone Number: mobile: ( ) Work: ( ) Home: ( ) Atlas E-mail: @mail.valenciacollege.edu (Admission Notification will be sent here) Male Female Date of Birth Are you a U.S. citizen or permanent resident? Yes No Have you attended a Health Sciences Information Session? Yes No Have you satisfied all requirements on the Admission Criteria and Checklist in the current Dental Hygiene Program Guide? (See valenciacollege.edu/health, Guides & Updates.) Yes No Please list all colleges/universities/postsecondary institutions you have attended: If you have attended other institutions outside of Valencia, have you confirmed that your official transcripts have been submitted to Valencia and posted in your Atlas account? Yes No (Required in order for application to be considered.) To view your transcripts in Atlas: Login to Atlas, Go to Courses, Registration, Transcripts Please enter your TEAS information as it appears in your Atlas account. To view your TEAS score in Atlas: Login to Atlas, Go to Courses, Registration, Transcripts, View Test Scores If your TEAS score does not appear in your Atlas account, please contact the Assessment Center at: Assessment@valenciacollege.edu 1

If you have applied to another limited access Health Sciences program at Valencia in the past 12 months, indicate which one(s): Have you previously attended a Dental Hygiene program? If so, please list name(s) of institution(s) and dates attended: FILL OUT COURSE CHART BELOW (REQUIRED): All official transcripts must be submitted to Valencia and evaluated by the application deadline, including any AP/IB/CLEP official score reports (must be requested from collegeboard.org for AP/CLEP or ibo.org for IB). To check if AP/CLEP/IB score reports have been processed by Valencia: Login into atlas.valenciacollege.edu, go to Courses tab, Registration, Transcripts. E.g. ENC 1101 Z To verify that transcripts have been received and processed by Valencia: Login into atlas.valenciacollege.edu, go to Students tab, My Transcripts. Your application will be ineligible if you are missing any transcripts. 1. Enter grades for courses completed with a minimum grade of C (for Humanities, highest grade should be entered). 2. Enter AP/IB/CLEP for the grade, if applicable. You must submit official scores (see above instructions) and we cannot accept scores from other school transcripts. 3. Enter R as the grade if you are currently registered in a course. Certain courses are required to be completed prior to application deadline (see below). Admissions points will only be given for courses completed by the application deadline. 4. If you have not taken a course, please enter No or leave blank. Any blank spaces will be assumed to be courses not taken; therefore, please fill out chart carefully and completely. If you are unsure about a course, enter it just in case. 2

COURSE CHART (REQUIRED) Valencia Course prefix/ number Course prefix/ Number (if different) Required Credits * Indicates courses required to be completed by the application deadline Grade Name of Institution attended Term/Year taken (e.g. Fall 2014) BSC 2093C 4 BSC 2094C 4 *Human Anatomy & Physiology I *Human Anatomy & Physiology II MCB 2010C 4 *Microbiology ENC 1101 HUN 2202 3 3 *Freshman Composition I Essentials of Nutrition with Diet Therapy SPC 1608 PSY 2012 SYG 2000 HSC 1004 HSC 1531 SLS 1122 3 Fundamentals of Speech 3 General Psychology 3 Introduction to Sociology 3 Gen. Ed. Humanities requirement (highest grade) 3 Professions of Caring 3 Medical Terminology 3 New Student Experience What is your overall college GPA, including all transfer work? Are you a graduate of a CODA Accredited Dental Assisting Program (Certified Dental Assistant)? Yes No (Must attach proof of graduation from a CODA accredited dental assisting program) Are you a Career Pathways/Tech Prep Graduate from high school? Yes No (Attach documentation.) Were you selected as an Alternate in Valencia s Dental Hygiene Program from the previous year? Yes No 3

DENTAL HYGIENE CORE PERFORMANCE STANDARDS FOR ADMISSION AND PROGRESSION Dental Hygiene is a practice discipline with cognitive, sensory, affective, and psychomotor performance requirements. Based on these requirements the following list of "Core Performance Standards" has been developed. Each standard has an example of an activity or activities, which a student will be required to perform while enrolled in the Dental Hygiene Program. These standards are a part of each Dental Hygiene course and of the professional role expectation of a Dental Hygienist. For the purpose of the Dental Hygiene Program, a qualified individual with a disability is one who, with or without reasonable accommodations or modifications, meets the essential eligibility requirements for participation in the program. The Division of Allied Health at Valencia makes no preadmission inquiries concerning an applicant s disability status. Information related to an applicant s disabilities is not a part of the information reviewed by the Admission Committee. These Performance Standards should be used to assist students in determining whether accommodations or modifications are necessary for the student to meet program requirements. A student who identifies potential difficulties with meeting the Performance Standards should communicate his/her concerns to an advisor in the Office for Students with Disabilities. The student has the responsibility to identify and document the disability and to request reasonable and appropriate adjustments. Determination is made on an individual basis as to whether any accommodations or modifications can be reasonably made. ISSUE Critical Thinking Interpersonal Communication Mobility Motor Skills Hearing Visual Tactile STANDARD Critical thinking ability to exercise clinical judgment Interpersonal abilities sufficient to interact with individuals, families, and groups from a variety of social, emotional, cultural, and intellectual backgrounds Communication abilities sufficient for interaction with others in verbal and written form Physical abilities sufficient to move from room to room and maneuver in small spaces Gross and fine motor abilities sufficient to provide safe and effective dental hygiene care Auditory ability sufficient to monitor and assess health needs Visual ability sufficient for observation and assessment necessary in dental hygiene care Tactile ability sufficient for physical assessment SOME EXAMPLES OF NECESSARY ACTIVITIES (NOT ALL INCLUSIVE) Identify cause-effect relationships in clinical situations; develop dental hygiene care plans Establish rapport and working relationships with patients/ clients and colleagues Explain treatment procedures; initiate health education; document and interpret dental hygiene actions and patient/client responses Moves around in dental operatories; clinic areas; work spaces, and treatment areas; administer cardio-pulmonary procedures Perform dental hygiene instrumentation skills; calibrate and use equipment; position patients/clients Hears monitor alarms; emergency signals; auscultatory sounds; cries for help Observes patient/client responses; assesses oral conditions Perform palpation during head and neck examination; record vital signs; detect calculus I have read and understand the above performance standards necessary to be a competent Dental Hygienist. Signature 4

For admission consideration, you must submit this application with any required documentation and have all of your grades posted to your Valencia transcript by the Dental Hygiene Program application deadline. DECLARATION I have reviewed all admission requirements and expectations in the Valencia Dental Hygiene Program Guide. I understand that it is fraudulent to misrepresent any information on this application and I affirm that all information on this application is true. I understand that, if admitted to this program, I must submit to a criminal background check, fingerprinting, and drug screening, document immunizations and other requirements for clinical participation, and be free of offenses that would disqualify me from the program. I have read and understand the performance standards necessary to be a competent Dental Hygienist. Signature Date HOW TO SUBMIT APPLICATION: A non-refundable Health Sciences Program Application fee of $15 must be submitted to the Business Office http://valenciacollege.edu/businessoffice with each application. By mail: Please mail the application together with a check or money order payable to Valencia College to the address listed below. Do not send separately. Valencia College Business Office 4-6 PO Box 4913 Orlando, FL 32802 In-person: Please make payment by credit card, debit card, cash, check, or money order (a check or money order must be payable to Valencia College) to the West Campus Business Office in the Student Services Building (SSB), Room 101 before turning in your application to the Health Sciences Advising Office on the West Campus in Building 1, Room 130. OR Please make payment to the Business Office on any Valencia campus and request that the Business Office staff forward your Health Sciences Program Application and application fee receipt to the Health Sciences Advising Office on West Campus. 5

Change of Program/Major Please submit the attached *Change of Major form along with your health science program application. DO NOT submit this form to the Answer Center. *This Change of Major form will ONLY be processed if you have received an acceptance letter and if you have confirmed acceptance into your chosen health science program. Please read the instructions below if the form is not filled out correctly, this will delay the processing of your change of major. Instructions Page 1 of Change of Major Form: Fill in your Last Name, First Name, Middle Initial, Maiden Name if appropriate, Valencia Identification Number (VID) and Date of Birth. For #1, fill in the names of all previously attended colleges in the space provided. For #2, Primary, enter name of your chosen health science program Sign and date at the bottom of the page. Page 2-3 of Change of Major Form: Locate your program and check the box next to your chosen health science program. NOTE: If you have not yet earned an AA (Associate of Arts) degree, you may choose it as a Secondary program/major. If you have questions about filling out the Change of Major Form: Email: HealthScienceAdvising@valenciacollege.edu and include your VID number and enter Change of Major in the subject line. In-Person: Health Science Advising Office, West campus, 1-130, during normal business hours Last updated 11-2-16 6

CHANGE OF PROGRAM/MAJOR FORM Please type or print in ink your name as it currently appears on your Valencia records. LAST NAME FIRST NAME M.I. MAIDEN NAME VALENCIA ID/SOCIAL SECURITY NUMBER DATE OF BIRTH COLLEGE USE Completed by: Date Month Day Year Campus of Record: q E q W q OSC q WP q LN WHAT INFORMATION WOULD YOU LIKE TO UPDATE? q Program/Major q Admit Term q Meta-Major q DirectConnect CHANGE OF PROGRAM/MAJOR Change of Program requests received after the Drop/Refund Deadline for a term will be processed for the following term. To change to a degree-seeking student, all official transcripts (high school and/or college) must have been received by Valencia. To be considered degree-seeking at Valencia, students must have a standard high school diploma, completed a GED, or have transfer work from a regionally accredited institution and must complete and satisfy assessment requirements. 1. List all colleges attended: 2. Indicate your primary (1) and/or secondary (2) choice of program or technical certificate. (See page 2 of this sheet for list of programs.) Primary Secondary Catalog Term* * If you indicate a catalog term and you are pursuing two programs, the catalog term will be updated for both programs. Catalog terms are in effect for five years; however, if you change your program you will be required to follow the catalog term currently in effect at the time you submit your change of program request. 3. If you no longer plan to pursue a specific program, degree or certificate, please check the selection below that best describes your situation: Job Improvement q Do not intend to earn a Valencia degree (Personal Interest) q Teacher Recertification q Transient Student ( You will be transferring credits to your home institution where you will be obtaining your degree) Change of interest CHANGE OF ADMIT TERM Change term from (choose one) q Fall q Spring q Summer Change term to (choose one) q Fall q Spring q Summer META-MAJOR SELECTION The following meta-major academic pathways are established for the purposes of aligning your intended academic and career goals. For more information, please refer to Florida Statute S. 1008.30. Select one of the following below to indicate which meta-major you would like: q Arts, Humanities, Communication and Design q Industry/Manufacturing and Construction q Business q Public Safety q Education q Science, Technology, Engineering and Mathematics q Health Sciences q Social and Behavioral Sciences and Human Services CHANGE OF DirectConnect CLASSIFICATION 1. After you complete your degree at Valencia, are you planning to complete a bachelor s degree with the University of Central Florida? q Yes q No If not at UCF, where? 2. If you indicated a Florida institution above, do you agree to allow Valencia to release your academic record to that institution? q Yes q No What is your expected date of graduation from Valencia? STUDENT SIGNATURE (REQUIRED) DATE 1

MAJORS AT VALENCIA Select your primary and/or secondary program interest and enter your selection on page 1 of this form. Bachelor of Science (B.S.) q Cardiopulmonary Sciences*** (indicate concentration): Community Health Non-Invasive Cardiology q Electrical and Computer Engineering Technology*** (indicate concentration): Audio and Electro-Acoustical Systems Computer Systems Electrical/Electronic Systems Laser and Photonics q Radiologic and Imaging Sciences*** (indicate concentration): Computed Tomography Magnetic Resonance Imaging Quality Management Associate in Arts (A.A.) Students may earn only one A.A. degree. If you have already completed an A.A. or Bachelor s degree at Valencia College or at another institution, you may not seek another A.A. degree at Valencia College. q Associate in Arts q Articulated Architecture (University of Central Florida) q Articulated Architecture (University of Florida) q Articulated Art, Studio/Fine Art (Ringling College of Art and Design) q Articulated Computer Science (University of Central Florida) q Articulated Electrical and Computer Engineering Technology (Valencia College) q Articulated Engineering (Florida Institute of Technology) q Articulated Engineering (Polytechnic University of Puerto Rico, Orlando Campus) q Articulated Engineering (University of Central Florida) q Articulated Engineering (University of Miami) q Articulated Information Technology (University of South Florida) q Articulated Information Technology (University of Central Florida) q Articulated Logistics/Management (Florida Institute of Technology) q Art, Studio/Fine Arts Pre-Major q Aviation Management q Dance Performance Pre-Major*** q Early Childhood Education q Music Performance Pre-Major q Sign Language Interpretation Pre-Major q Theater/Drama/Dramatic Arts Pre-Major Associate in Science (A.S.) q Accounting Technology q Baking and Pastry Management q Biotechnology Laboratory Sciences q Building Construction Technology q Business Administration Articulated A.S. to B.A./B.S. Career Path in General Business Administration Finance Human Resources Management International Business Management Marketing Property and Casualty Insurance Management Real Estate Management Small Business Management q Cardiovascular Technology* q Civil/Surveying Engineering Technology q Computer Information Technology q Computer Programming and Analysis q Criminal Justice Technology (Articulated) Homeland Security q Culinary Management q Dental Hygiene* q Diagnostic Medical Sonography* q Digital Media Technology Live Event Video Production Mobile Journalism Video and Motion Graphics Web Development q Drafting and Design Technology q Electronics Engineering Technology Electronics Laser and Photonics Robotics and Mechatronics Telecommunication and Wireless q Emergency Medical Services Technology* q Entertainment Design and Technology Live Show Production Production Design q Film Production Technology q Fire Science Technology*** Fire Officer Specialization Fire Prevention q Graphics and Interactive Design Technology Graphic Design Interactive Design q Health Information Technology*** q Hospitality and Tourism Management Career Path in Hospitality and tourism Management Career Path to B.S. in Hospitality Administration/ Management (Articulated A.S. to B.S.) q Industrial Management Technology*** q Landscape and Horticulture Technology Horticulture Landscape q Medical Office Administration Medical Front Office Medical Transcription q Network Engineering Technology Cisco Routing and Switching Cyber Security and Digital Forensics Microsoft Systems Administration q Nursing, R.N. (Articulated)* Online R.N. Advanced Standing Track* q Office Administration q Paralegal Studies (Articulated) Litigation Transactional q Radiography* q Respiratory Care* q Restaurant and Food Service Management Career Path in Restaurant and Food Service Management Career Path to B.S. in Restaurant and Food Service Management (Articulated A.S. to B.S.) q Sound and Music Technology Audio and Music Business Management Audio Engineering Technology Music Production Sound Production q Veterinary Technology** *** This is a limited access, selective admissions program that requires an additional application. Contact the specific department for more specific information. An Associate in Arts in General Studies will be added to your student record if you have not been previously awarded an A.A. degree or higher. This will allow you to take prerequisite courses for the limited access program. *** For information on this program, see the online catalog. Students pursuing this program may choose to receive an Associate in Arts degree; Veterinary Technology degree is awarded by St. Petersburg College. *** This is a limited access, selective admissions program that requires an additional application. Contact the specific department for more information. 2

MAJORS AT VALENCIA Select your primary and/or secondary program interest and enter your selection on page 1 of this form. Advanced Technical Certificate (ATC) q Computed Tomography*** q Magnetic Resonance Imaging*** Technical Certificate/Career Certificate/Applied Technology Diploma Programs q Accounting Applications q Accounting Operations q Accounting Specialist q Advanced Electronics Technician q Advanced Network Administration q Advanced Network Infrastructure q Baking and Pastry Arts q Basic Electronics Technician q Building Construction Specialist q Business Management q Business Operations q Business Specialist q Chef s Apprentice q Computer Information Technology Analyst IT Security IT Support q Computer Information Technology Specialist q Computer Programming Computer Programming Web Development q Computer Programming Specialist Computer Programming Web Development q Criminal Justice Institute*** Correctional Officer Law Enforcement Officer Crossover: Corrections to Law Enforcement Auxiliary Law Enforcement Officer q Criminal Justice Technology Specialist q Culinary Arts q Culinary Arts Management q Customer Service Management q Customer Service Operations q Customer Service Specialist q Cyber Security q Digital Broadcast Production q Digital Forensics q Digital Media Development q Digital Media Video Production q Digital Media Web Production q Digital Video Editing and Post-Production q Digital Video Fundamentals q Drafting Architectural Drafting Mechanical Drafting Surveying Drafting q Drafting AutoCAD q Emergency Medical Technology (EMT) q Entertainment Stage Technology q Entrepreneurship q Film Production Fundamentals*** q Fire Services Central Florida Fire Institute at Valencia*** Fire Apparatus Operator Fire Fighter Minimum Standards Fire Officer Supervisor q Graphic Design Production q Graphic Design Support q Graphics Interactive Design Production q Graphics Interactive Design Support q Homeland Security Specialist q Homeland Security Law Enforcement Specialist q Hospitality Event Planning Management q Hospitality Food and Beverage Management q Hospitality Guest Services Specialist q Hospitality Rooms Division Management q Human Resources Management q Human Resources Operations q Human Resources Specialist q International Business Specialist q Landscape and Horticulture Professional q Landscape and Horticulture Specialist q Landscape and Horticulture Technician Horticulture Landscape q Laser and Photonics Technician q Medical Office Management q Medical Office Specialist Medical Front Office Medical Transcription q Medical Office Support q Network Administration q Network Infrastructure q Network Support q Office Management q Office Specialist q Office Support q Paramedic Technology*** q Rapid Prototyping Specialist q Real Estate Specialist q Robotics and Mechatronics Technician q Sound and Music Production Audio Visual Production q Webcast Media q Webcast Technology *** This is a limited access, selective admissions program that requires an additional application. Contact the specific department for more information. 2015 Valencia College 14ADM017 3