BASDH - Dental Hygiene Program
Application for Admission
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By checking this box I certify that I am in good standing with all previous academic institutions
(colleges, universities, technical schools) that I have attended. “Good standing” means the stu-
dent has resolved any unpaid fees or acts of academic or behavioral misconduct and complied
with all sanctions imposed as a result of any misconduct.
Plan of Completion of all Prerequisite Coursework
❑ By checking this box I certify that ALL Prerequisites are complete! Proceed to bottom of page
and provide signature
Prerequisites courses incomplete or in progress
Enter plan of completion below and provide signature
Print Sign Date
Columbia Basin College complies with the spirit and letter of state and federal laws, regulations and executive orders pertaining to civil rights, Title IX, equal opportunity and affirmative action. CBC does not discriminate on the ba-
sis of race, color, creed, religion, national or ethnic origin, parental status or families with children, marital status, sex (gender), sexual orientation, gender identity or expression, age, genetic information, honorably discharged veteran or mil-
itary status, or the presence of any sensory, mental, or physical disability, or the use of a trained dog guide or service animal (allowed by law) by a person with a disability, or any other prohibited basis in its educational programs or employ-
ment. Questions or complaints may be referred to the Vice President for Human Resources & Legal Affairs and CBC’s Title IX/EEO Coordinator at (509) 542-5548.Individuals with disabilities are encouraged to participate in all college
sponsored events and programs. If you have a disability, and require an accommodation, please contact the CBC Resource Center at (509) 542-4412 or the Washington Relay Service at 711 or 1-800-833-6384. This notice is available in alternative media by request.
