Dental Assisting Program Application Process

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Dental Assisting Program 2018-2019 Application Process Step 1: Step 2: Step 3: Apply at TSTC admissions/financial aid Departments Attend an information Session Download application packet from TSTC Dental program website http://tstc.edu/programs/dentalassistant http://www.tstc.edu/programrequirements/dentalassistant?_ga=2.218237209.162151 6191.1518469325-1847329053.1516390343 Step 4: Turn in application packet completed from March 19, 2018 to July 27, 2018 Step 5: Attend a MANDATORY Pre-Orientation. July 27, 2018. Only applicants with 100% completed packet will notified for this meeting. Applicant will be notified by text. (Make sure we have correct and current phone number) Step 6: Class chosen. You will be notified by mail, if you are part of the 2019 Class of Dental Assisting. Good Luck!!!! Any questions come by or call Dental Assisting Department 254-867-4864

Dental Assistant Department 3801 Campus Drive Waco, Texas 76705 254-867-4864 254-867-2239 Dental Assisting Program Information Sessions This is an information session about: When to apply How to apply Important dates Questions and answers Place: Dental Assisting Building, Room 119 Dates will be on: Friday, March 2 @ 1:30pm Friday, March 30th @ 1:30pm Friday, May 4th @ 1:30pm Please sign up with the building secretary, Laura @ 254-867-4864, for the date you are interested in attending. Thank you, Lisa Huffhines Lead Instructor Dental Assisting Program

Dental Assistant Department 3801 Campus Drive Waco, Texas 76705 254-867-4864 254-867-2239 Dear Dental Assistant Applicant, Welcome, we are very proud of the excellent Dental Assistant Program offered here at TSTC, and we are glad you wish to be a part of it! This packet of information has been prepared to help guide you through the application process. Our program is an accelerated two-semester, certificate program. This program offers hybrid courses, which consist of a combination of hands-on labs and online assignments. Students can expect to spend much of their time studying and preparing for each course. Advanced reading levels, high comprehension skills, superior customer service, and digital dexterity are vital to your success. This program requires dedicated students with excellent study habits, who are self-motivated and organized. We are excited about being a part of your decision to join our program, which will put you on the path to becoming a Registered Dental Assistant. Best Wishes, Lisa Huffhines, BAAS, RDA Lead Instructor

Dental Assistant Certificate Semester 1 Lecture Lab Total Credit DNTA 1305 Dental Radiology 2 3 80 3 DNTA 1415 Chairside Assisting 2 4 96 4 DNTA 1241 Dental Laboratory Procedure 1 3 64 2 DNTA 1351 Dental Office Management 2 2 64 3 Total Hours 7 12 304 12 Semester 2 DNTA 1301 Dental Materials 2 4 96 3 DNTA 1353 Dental Assisting Applications 2 4 96 3 DNTA 1660 Clinical-Dental Assistant 0 0 288 6 Total Hours 4 8 480 12 Grand Total 11 18 784 24 Course designated as capstone course. Course with external learning experience. Please Note: Due to safety reasons students may not enroll in DNTA 1305 or DNTA 1660 while pregnant. Dental Assistants are a critical part of a successful dental team. If you enjoy working with your hands, are an effective communicator, great listener, and want the responsibilities that come along with a professional career, dental assisting might be for you. The Dental Assistant program at Texas State Technical College offers the necessary training needed to enter the field. Students will learn to set up exam rooms, measure blood pressure, expose radiographs, take impressions, pour molds, and fabricate temporary crowns. The United State Department of Labor states that dental assisting is among the fastest growing professions in the health provider field. Dental Assistants are in high demand throughout the nation and as the population ages and the need for health care grows, this trend is expected to continue. Salaries for Registered Dental Assistants average from $8.50 to $14.00 per hour in the Waco/Temple/Killeen area, and can be as high as $36,000 per year in metropolitan areas such as Austin, Houston, or D/FW.

How Do I Apply? Step 1: A. Apply to Texas State Technical College. Complete the application on the TSTC website utilizing the online application system: https://apply.tstc.edu/ B. Provide proof of immunization against bacterial meningitis. (Additional copy of immunization record is required for DA application.) This law does not apply to students age 22 and over, nor to students who are enrolled only in online classes. C. Request official transcripts, from high school and each college previously attended, to be sent to the Admissions and Records office. D. If necessary, meet with a financial aid representative. E. Meet with a Success Coach for advisement and potential testing. Submission of the completed college application does not guarantee acceptance into the Dental Assistant Program. Step 2: A. Complete the Texas State Technical College Dental Assistant Program Application Form. B. Complete the Drug/Background Screening Consent Forms C. Obtain an official copy of immunization record containing: i.hepatitis B injection 1 st series ii.hepatitis B injection 2 nd series iii.hepatitis B injection 3 rd series iv.tetanus-diphtheria-pertussis within past 10 years v.measles, Mumps and Rubella 2 series vi.tb skin test (negative result) required at registration and to remain current throughout clinical practicum vii.varicella or date of chickenpox disease D. Obtain a copy of current CPR card in basic life support. Must be Hands On and valid until three months after anticipated graduation date. Step 3: At the time of registration for the Fall or Spring semesters, all forms or documentation listed in STEP 2 must be brought to the Dental Assistant Program for further advisement. During the advising stage, you will submit to drug and background screenings. Your Dental Assistant advisor will give you the forms and information required to proceed with the drug and background screenings. We will not accept any drug/background screening results prior to advisement. These screenings will be administered by:

i. Drug: Any Lab Test Now. Follow the link for more information http://www.anylabtestwaco.com/. You will have a two hour window to submit to the screening. Drug screening fee is $49.00 and all costs will be incurred by the student. ii. Background: IdentoGo, https://uenroll.identogo.com/workflows/11ft12 or by calling 1-888-467-2080. The cost of the service is $25.00 paid to MorphoTrust USA at the time of scheduled appointment. (These forms will be given to you when you come in for Advisement) Once we receive a cleared Drug/Background Screenings, you will be notified by Dental Assisting Staff. You will then return to the Dental Assistant department to complete the registration process. (48 students accepted Each Fall and Spring Semesters) Once Registered with Dental Staff, you will then proceed to the Student Services Center to reconcile your bill. Afterward you can purchase the necessary textbooks required for class and obtain your Tech One card. Step 4: Attend a MANDATORY Pre-Orientation. Only applicants with 100% completed packet will notified for this meeting. Applicant will be notified by text. (Make sure we have correct and current phone number) Step 5: Class chosen. You will be notified by mail, if you are part of the 2019 Class of Dental Assisting. Drug/Background Screening Guidelines: 1 st Drug Screening Entrance Requirement into Program 2 nd Drug Screening Entrance Requirement in the Clinical Practicum Background Screening Entrance Requirement into Program (Used for advisement only in acquiring Registered Dental Assistant License) Incoming students should initiate a drug screen ONLY upon direction from the department. Drug/Background Screening Cost: 1 st Drug Screening: $49.00-First Semester 2 nd Drug Screening: $39.00 -Second Semester, Random IdentoGo Background Screening: $25.00 All students will be responsible for the cost of each screening. Drug Screening Results Negative Screen Student is eligible to register for classes and/or clinical placement. Positive Screen New applicants who test positive for drugs will not be accepted into the Dental Assistant Program. All students testing positive will not be eligible to re-apply for a minimum of twelve months.

Second semester Dental Assistant students who submit a positive drug screening will be administratively withdrawn from all Dental Assistant related courses immediately. Students will also adhere to campus disciplinary actions as defined in the Student Code of Conduct. After all disciplinary sanctions have been satisfied and the student has met with the Dental Assistant Department Chair, the student may be eligible for re-enrollment after a twelve month period and required to re-start the program. This does not guarantee re-admission into the program. A positive drug screen is any instance in which a drug screening report shows a positive test for one or more of the drugs on the panel. Failure to submit to drug screening A first semester student will not be eligible for enrollment. Second semester students who fail to undergo the drug screening in the time required will be administratively withdrawn from all Dental Assistant related courses immediately. Positive for prescription drugs : Students currently taking medication as prescribed by a physician are required to bring, at the time of the screening, a pharmacy issued up-to-date medication list as supporting documentation. This list will be turned into the personnel at Any Lab Test Now at the time of screening. If you cannot provide supporting documentation the student will pay an extra fee for a Confirmation Drug Screening. The following criminal histories will disqualify an applicant from consideration for the Dental Program: a. listed as a registered sex offender, b. all felony convictions, c. felony deferred adjudications involving crimes against persons, d. theft- Class B or above, e. any weapons charge, f. any violence-class B or above, g. drugs, Class B or above, and h. any abuse or neglect offenses. All information and test results received by TSTC Waco will become a part of the students official educational record and will be protected through the Family Rights and Privacy Act.

General Information What will my class schedule look like the 1 st and 2 nd semester? All first semester classes are offered in a morning or afternoon period. Our department offers some flexibility which will allow students to maintain a part-time job during the first semester if they desire. During the second semester you will be unable to work during the hours of 8:00 a.m. 5:00 p.m. Monday through Friday, due to your clinical assignment. Expect to spend 6-8 hours per week at home completing the necessary work for each course. Can I work a full-time job while in the program? It will become very difficult to fulfill all course work required for each course and maintain a full-time job. Do I have to know how to read? Yes, reading is a very important part of your success in this program. Most of the dental textbooks require a high level of reading and comprehension skill set. How much does the program cost? As an estimate, the program will cost about four thousand dollars. What is the dress code? All students are required to wear scrubs when attending labs in the DA building. Students are free to select any brand of Navy color scrubs and Black tennis shoes to wear to labs. In addition, Clinical students may be required to wear office designated scrubs when completing their rotations. What documents should I bring when registering to the Dental Assisting Program? Dental Assistant Program Application Drug/Background Screening Consent Form Official Copy of Immunizations Copy of Current CPR card in basic life support (no online CPR courses accepted) Where will I be placed to do my Clinical Rotation? Your instructor will find the best available option for student placement at the time of your clinical rotation. Your clinical assignment may not be local and students should be prepared to travel outside of the Waco area.

Application Form Dental Assistant Program 3801 Campus Drive Waco, TX 76705 254.867.4864 Answer ALL questions. Please print legibly. Complete in blue ink. First Middle Last Mailing Address: Number & Street or PO Box City State Zip Physical Address (if different from above): Date of Birth Home Phone: Cell Phone: Business Phone: E-mail Address: In case of emergency notify: Name Relationship Address: Phone: Number & Street City State Zip I understand that as a Dental Assistant Student, I will be exposed to blood and bodily fluids. Texas State Technical College will not be held responsible for injury sustained during clinical experiences. As a student, I am to carry my own medical, accident, and liability insurance. Proof of such insurance must be kept on file in the Dental Assistant Program Office. I also understand that as a Dental Assistant student I will be required to obtain the Hepatitis B vaccination series and maintain a current tetanus and tuberculosis test on file. I understand that as a student I must comply with state and federal HIPAA privacy protection policies. I further understand that to determine my status for admission, officials of Texas State Technical College will rely upon the information submitted herein. I certify that the information in this application is complete and correct and understand that the submission of false information is grounds for rejection of my application, withdrawal of offer of my acceptance, cancellation of enrollment, or appropriate disciplinary action. TSTC Dental Assistant Programs comply with all institutional, local, state, and federal regulations on ionizing radiation, hazardous material, HIPAA privacy policies, and bloodborne and infectious diseases. I hereby certify that the information contained in this application is true and complete to the best of my knowledge. Signature of Applicant Date

Texas State Technical College (TSTC) is an affirmative action/equal opportunity employer. Applicants are considered on the basis of qualifications without regard to gender, age, race, color, creed, religion, national or ethnic origin, veteran status or the presence of a non-job-related disability or any other legally protected status. I understand that Dental courses are Hybrid, which means bookwork/tests/homework will be done at home,you will be required to come to class your scheduled time for labs. This is not a traditional style class where an instructor is going over book work with you in the classroom. Students can expect to spend much of their time studying and preparing for each course at home. Advanced reading levels, high comprehension skills, superior customer service, and digital dexterity are vital to your success. This program requires dedicated students with excellent study habits, who are self-motivated and organized. Signature of Applicant Date

Medical and Radiation History Name Date of Birth Age Address City State Zip Code Occupation Phone Social Security Number Married Single Name of Spouse or Parent you currently live with Phone Medical History Physician Office Phone Approximate date of last physical examination Are you in good health? YES NO Are you under medical treatment now? YES NO (If so, for what?) Are you taking any medication now? YES NO (If so, please list) Are you allergic to penicillin or other medication? YES NO (If so, please list) Do you have a history of fainting? YES NO Do your gums bleed? YES NO Do you have any inflamed areas, or sore spots in or around your mouth? YES NO Do you have any other dental complaints? (please specify) Has a physician ever informed you that you had: (check any of the following that apply) Diabetes High Blood Pressure A Heart Ailment Respiratory Disease Rheumatic Fever Tumors or Growths Rheumatism or Arthritis Hepatitis, Jaundice or Liver Disease Blood Disease Kidney Disease Stomach or Intestinal Disease Venereal or other sexually transmitted disease AIDS or HIV Infection Epilepsy

Are you pregnant or do you suspect you might be pregnant? YES NO If so, what i s your due date? Radiation History Have you ever had any X-Ray Treatments (other than diagnostic)? YES NO REASON? When was your last full mouth X-Ray taken? Where? Have you had any type of radiation in the last six (6) months? YES NO REASON? I confirm that all the above information is correct, that I am not pregnant or suspect that I am pregnant, and that I have not had any radiation within the past six(6) months. I give permission for a TSTC Dental Assistant student to take dental x-rays on me under direct supervision of a dentist, and I understand that any diagnosis and treatment needed will be determined by the dentist who requested the x-rays. Sign your full name: Date: I confirm that all the above information is correct, and that I will inform the DA staff of any changes that may occur to my medical/health history while I am a student here, such as becoming pregnant, or any other medical situation that may arise. I agree to be a learning partner to allow fellow TSTC DA students to demonstrate specific chairside procedures on me, as recommended by the DA staff. If there is any reason that you should not participate in being a learning partner, please indicate here: RADIATION / PREGNANCY RELEASE FORM Faculty and Staff of the Dental Assistant Program are currently being legally advised by the campus lawyer regarding the continuation of pregnant students to take DNTA 1305 and DNTA 1660. Until a firm decision can be reached, we will continue to restrict pregnant students from taking DNTA 1305 and DNTA 1660 until after the birth of the child. There are many hazards that the dental assistant student will confront before and during their practicum, including the following: Lead Lead, which is often used in manufacturing processes, has been linked to miscarriages, deformities, and premature births. Radiation Certain X-rays emit radiation that is linked to miscarriages and birth defects. Chemicals At least 26 substances have been linked to problems for pregnant women, including lead, alcohol, mercury, carbon monoxide, benzene, and toluene. Viruses Health professionals are often exposed to the rubella virus and cytomegalovirus (CMV), both of which are hazardous during pregnancy. Rubella during the first three months of pregnancy may cause severe birth defects in the fetus; CMV can be passed along to a fetus, causing handicaps such as blindness,

hearing loss, and cerebral palsy. There may also be exposure to various other blood-borne pathogens, needle sticks, contaminated instrument punctures, etc. You will not be allowed to register for or participate in DNTA 1305 and/or DNTA 1660 until after the baby is born. Even if you have received permission from your attending physicians, we do not think that they are completely aware of these hazards. Example: If a pregnant student is doing her practicum and becomes exposed to a patient with hepatitis, the student cannot take preventive measures due to pregnancy. Texas State Technical College cares about the health and well-being of our students and their unborn children. Consequently, the college requires you to sign below releasing TSTC, the Dental Assistant Program, and the dental facility you will be assigned to of any liability in this area should you become pregnant during your clinical assignment. We also cannot be held responsible if a dentist chooses to release you from his or her facility due to false representation. I fully understand the above and being pregnant, will make the necessary arrangements to drop these courses. being not pregnant, continue these courses. Signature Date Drug/Background Screening Consent Form As a student applying for entry into the Dental Assistant Program at Texas State Technical College Waco, I understand that I will be required to submit a Drug/Background Screening prior to registration of classes and again for drug screening prior to placement in a clinical practicum rotation. I also understand that my participation in the DA program is contingent upon my agreeing to undergo substance screening with negative results. I further understand that if my test results are positive for illicit drugs or Criminal Background History Standards, I will be administratively withdrawn from all Dental Assistant related courses and will not be eligible to reapply for a minimum of twelve months. I hereby authorize Any Labs Test Now and Identogo, to conduct such screening and to provide the results to Texas State Technical College. I release Texas State Technical College, and any person affiliated with Texas State Technical College, and any institution or person conducting the screening, from liability herein. Student s Signature Date Student s Name (Please Print) *Drug Test Facility/Any Lab Test Now/ 8810 W Hwy 84 #301, Waco Tx 76712 *IdentoGo-State Agency/ 5016 W Waco Dr Waco, TX 76710-7022

Dental Assistant Questionnaire 1. What made you want to become a dental assistant? 2. What do you think the duties of a dental assistant are? 3. When was your last dental visit? With whom? 4. Are you familiar with all aspects of email? Yes No 5. Our program is computer based, how proficient are you with computers? 6. You will be scheduled and required to attend 12 hours a week in the Dental Assistant building during your first semester. Conflicting responsibilities can include but are not limited to, transportation issues, job requirements, and/or childcare. Will any of this conflict with your school schedule? Yes No If you answered yes, please explain below. 7. During the second semester you will be registered for DNTA 1660, Dental Assistant Clinical. You must meet the following requirements to successfully complete this course. a. Have dependable transportation to your assigned clinical office. b. Participate in minimum of 32 hours of clinical assignment per week. c. Participation in this course will not allow you to work during these required course hours. d. Students cannot have conflicting responsibilities which can include but are not limited to, transportation issues, job requirements, and/or childcare during clinical assignments. (Example: Students who work between the hours of 8:00 a.m. to 5:00 p.m. Monday through Friday have had to quit their jobs in order to successfully complete DNTA 1660 Dental Assistant Clinical.) e. Purchase two sets of office designated scrubs to wear during clinical rotations. Do you understand and agree to these requirements? Signature Date

Technical Standards (Physical Criteria) for Dental Assistant Program Visual Acuity 1. Acute enough to read small printed labels on medications. 2. Acute enough to read small numbers on instruments. Hearing Acuity 1. Acute enough to hear and understand words spoken when muffled by a mask. 2. Acute enough to hear blood pressures and heart rate with stethoscope. Speaking Ability 1. Verbal expression clear and distinct enough to enunciate dental terminology while wearing a face mask. 2. Ability to express thoughts clearly. Digital Dexterity 1. Agile enough to handle dental instruments with both left and right hands. 2. Able to bend at the wrist. Adaptive Ability 1. Able to complete required tasks/functions under stressful conditions. 2. Able to perform with minimal supervision. 3. Able to interact appropriately with all members of the dental team. Need to be able to communicate with all levels of people: age levels and socio-economic levels. Must be willing to learn to speak in public presentations. Must be able to speak and read English proficiently. Must have current Texas driver s license and personal transportation. Must have Social Security number. Survey Question: Did you tour the Dental Assisting Program here at TSTC while in junior high or high school? Yes No If yes, did the tour help you to decide to come into the Dental Assisting Program at TSTC? Yes No Name of student Name of faculty Signature of student Signature of faculty Date Date