Fillable DA Application 2019-2020 - DA Application 2019-2020

Fill Online, Printable, Fillable, Blank DA Application 2019-2020 - DA Application 2019-2020 Form

Use Fill to complete blank online DIABLO VALLEY COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

DA Application 2019-2020 - DA Application 2019-2020

On average this form takes 17 minutes to complete

The DA Application 2019-2020 - DA Application 2019-2020 form is 7 pages long and contains:

  • 0 signatures
  • 13 check-boxes
  • 60 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Diablo Valley College

BROWSE DIABLO VALLEY COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Overview
Thank you for your interest in the Diablo Valley College Dental Assisting Program. We are pleased that you are exploring
dental assisting as a profession. Registered Dental Assistants are an essential member of the dental team, which include,
preparing patients for treatment, assisting the dentist with a wide variety of treatment procedures, taking & developing x-
rays, sterilizing dental instruments and patient education. They may work for general dentists or specialists in areas such
as orthodontic, endodontic, surgery, and pediatric dentistry.
Attitudes and Characteristics of the Successful Registered Dental Assistant
• Attention to detail
• Enjoy working with a diverse population of employees and patients
• Flexible, ethical, reliable, , timely, and exhibits the manual dexterity, visual and auditory acuity and motor coordination
necessary
• Patient, emotionally stable, demonstrates sound judgment, tact and self-control.
• Able to work directly under a dentist’s direction, can follow written and verbal instructions, accepts responsibility for the
results of his/her actions
• Team player who works within the parameters of the dental assisting scope of practice in an ethical manner and who is
able to communicate with health team members and patients
• Able to accept constructive criticism and perform self-evaluation activities which result in personal and professional
growth
Program Description
The DVC Dental Assisting Program is accredited by the American Dental Association Commission on Dental Accreditation
and by the United States Department of Education and has also been approved by the Dental Board of California. The
goal of the Diablo Valley College Dental Assistant Program is to graduate students that have demonstrated competencies
in clinical and administrative practices as well as demonstrated work ethics and professional values consistent with that of
the American Dental Assistants Association (ADAA) and the California Dental Practice Act (DPA). Graduates of the
program are eligible to take the California Registered Dental Assistant Examination and the Certified Dental Assistant
National Examination.
The program consists of two consecutive semesters (Fall & Spring) of full-time study and one summer session at the
beginning of the program. Students are involved in an administrative and clinical practicum in dental care settings in the
community. These may include managed care facilities, private dental practices, state and county clinics, dental schools,
and school-based oral health programs. Applicants are advised that a high level of dexterity, the ability to multi-task, and
a high degree of attention to detail are required for the successful completion of this program.
Dental Assisting Program
PROGRAM INFORMATION/APPLICATION GUIDE
FOR 2019-2020
Diablo Valley College Dental Assisting Application 2019
Page 2 of 7
Rev.: 10/01/2018
General Education Requirements
A Certificate of Achievement in Dental Assisting is mandatory for successful completion of the Dental Assisting Program.
Students must complete all course requirements before graduation to be eligible for the Dental Assisting National Board
Examination and Licensing Examinations held by the Dental Board of California. The following general education or
equivalent courses must be taken prior to or concurrently with the dental assisting requirements with a grade of “C” or
higher:
• COMM 120 – Public Speaking or COMM 130 – Small Group Communication
• BUS 101 – Business English or ENGL 117 – Integrated College Reading and Writing Development or ENGL
118 – College Writing Development or ENGL 122 – Freshman English: Composition and Reading
• PSYCH 101 – General Psychology or PSYCH 122 – Psychology in Modern Life
Students may also earn an Associate in Science in Dental Assisting which requires additional general education courses.
Please contact Counseling at (925) 969-2140 to schedule an appointment to develop an educational plan to help you achieve
your academic and career goals or if you have questions regarding coursework transferability and/or equivalency.
National and State Licensing Requirements
In addition to successfully completing the course of study in an approved dental assisting program, the California Dental
Practice Act requires that candidates for licensure be of good moral character and be citizens of the United States or
lawfully entitled to remain and work in the United States. Fingerprinting is required and checked by the Department of
Justice and/or the Federal Bureau of Investigation prior to state licensure. Prospective students are advised that if
they are not lawfully entitled to remain and work in the United States upon program completion, have felony or
misdemeanor convictions or have a history of substance abuse or infectious disease that this may preclude
subsequent licensure as a registered dental assistant in California. Additionally, students must have a social security
number or an individual tax identification number in order to apply for licensure in the State of California. Applicants
should contact the Dental Board of California for more information at www.dbc.ca.gov
Program Cost Estimate
The Dental Assisting Program current cost estimate for 2019-2020 is between $5,000-7,000, subject to change annually.
For financial assistance, contact the DVC Financial Aid office at (925)969-2009 or https://www.dvc.edu/ways-to-pay-
college.html
Policies for Admission
Admission to the DVC Dental Assisting Program is based on the general admission policies for DVC (see the DVC College
Catalog for General Admission Policies), guidelines consistent with state and federal law, and guidelines established by
the American Dental Association Commission on Dental Accreditation and the Dental Board of California. The program
provides equal opportunity in education and employment and does not discriminate on the basis of race, color, national
origin, sex, age or handicap in accordance with Titles VI and VII of the Civil Rights Act of 1964, Title IX of the Educational
Amendments of 1992 and Section 504 of the Rehabilitation Act of 1973.
Diablo Valley College Dental Assisting Application 2019
Page 3 of 7
Rev.: 10/01/2018
Process for Admission
Entrance into the Diablo Valley College (DVC) Dental Assisting Program is highly competitive with enrollment limited to 24
students and will be determined by a lottery. Applicants must register and attend DENTL 120 – Orientation to the Dental
Assisting Program held in the Spring 2019 semester. Admission is contingent upon completion of this course with a
grade of 75% or higher to formally be entered into the lottery for acceptance to the 2019-2020 Dental Assisting class.
The Orientation to the Dental Assisting Program will be offered:
DENTL 120 Orientation to the Dental Assisting Program - (P/NP) - .5 Unit
Students must register for one of the two sections (indicated below).
DENTL 120-3458 – March 5 and 6th, 2019
Lecture: Tuesday 1:00 – 4:00pm
Lab: Wednesday 8:30 - 11:20am
Note: Each student must attend the lecture and the lab to be eligible for the LOTTERY and acceptance into the Dental
Assisting Program.
DENTL 120-3459 – March 5 and 6th, 2019
Lecture: Tuesday 1:00 – 4:00pm
Lab: Wednesday 1:00 - 3:50pm
Note: Each student must attend the lecture and the lab to be eligible for the LOTTERY and acceptance into the Dental
Assisting Program.
DENTL 120-3458 & 3459 – April 24, 2019
Lecture: Wednesday 1:00 – 4:00pm
Note: This will be our orientation meeting for the Dental Assisting Class of 2019
Application Packet
Applicants may submit their application packet anytime during the Fall and Spring semesters prior to the offering of the
Orientation course. Application must include all of the following in one envelope to be used in determining eligibility for
the program:
1. Dental Assisting Program Applicant Check List form
2. Completed Dental Assisting Program Application form, including applicant’s signatures
3. Completed Worksheet for Certificate in Dental Assisting Degree
Previous Applicants
Applications are not carried over from one year to the next. If you wish to be considered as a candidate in each year, you
must submit a completed new application packet containing all materials as directed. Please refer to the DVC – Dental
Assisting Program website for the most up to date information regarding admission requirements:
https://www.dvc.edu/academics/departments/dental-assisting/apply.html
Diablo Valley College Dental Assisting Application 2019
Page 4 of 7
Rev.: 10/01/2018
Primary Admission Requirements for DVC Dental Assisting Program Applicants
1. Must have high school diploma or its equivalent.
2. Must complete DENTL 120 – Orientation for the Dental Assisting Program.
3. Submit a completed DVC Dental Assisting Program application packet.
Student Selection
Students who complete DENTL 120 – Orientation for the Dental Assisting Program with Passing (P) grade will be entered
into the State mandated lottery system for admission into the program. Admission is contingent upon completion of
this course with a grade of 75% or higher to formally be accepted into the 2019-2020 Dental Assisting Class.
If the student does not attend or successfully pass the orientation, the position in the class will be awarded to an alternate.
If a student declines their acceptance into the program, the position in the class will be awarded to an alternate. The
alternate list is only valid for the current application cycle.
Admission Requirements for DVC Dental Assisting Program Accepted Students
1. Prior to June 1st, students who have been chosen to be a part of the Class of 2020 will be required to show: (1)
Submit official, sealed and unopened transcripts from high school, it equivalent and college to Admissions and
Records; (2) proof of CPR BLS - American Heart Association for the Healthcare Provider certification; (3) required
immunizations/titers; (4) proof of a negative TB test; (5) results of a recent physical examination/screening; (6)
results of a certified background check; and (7) results of a certified drug test. Reporting documents will be handed
out during the orientation meeting.
Additional Information
No guarantee can be made that an applicant will be accepted into the dental assisting program. Making false statements
on the application, not passing the certified background check or drug test are cause for entrance denial or dismissal from
the program. If an applicant is not admitted into the dental assisting program, DVC offers other programs that may be of
interest. Please contact a DVC counselor for more information at (925) 969-2140.
Diablo Valley College Dental Assisting Application 2019
Page 5 of 7
Rev.: 10/01/2018
Dental Assisting Program A p p lication
Date
DVC 7 digit ID Number (Please apply as a DVC students to gain #)
Last Name
First Name
Middle
Other Used
Mailing Address
City
County
State
Zip Code
Home Telephone
Cell Telephone
Email Address
How did you find out about the DVC RDA program?
Have you attended DVC before?
Yes No
If "Yes", what year(s) did you attend
Have you attended another DA program?
Yes No
If "Yes", where and when did you attend, and what was the reason for leaving
Have you applied to the DVC DA Program before?
Yes No
If "Yes", list previous application year(s):
Are you a citizen of the United States? Yes No
Are you lawfully entitled to remain and work in the United States upon program completion? Yes No
Please list the name, starting and ending dates, and any degrees or certificates, for all high schools, colleges, technical and vocational schools attended. Also
include colleges in which courses were attempted although they may not have been completed.
Name of School
City and State
Dates Attended
Name and date of degree
awarded; or state “degree in
progress”; or “no degree”
1
2
3
4
5
Applicant's Certification
I hereby certify that I have personally read and completed the above application. I understand the application criteria and procedures for
the
Dental Assisting Program. I accept complete responsibility for requesting all required official documents. All information provided is true and
accurate.
Signature of Applicant Date of Application
Diablo Valley College Dental Assisting Application 2019
Page 6 of 7
Rev.: 10/01/2018
W orksheet for Certificate of Achievement in Dental Assisting
Please Note: A Certificate of Achievement in Dental Assisting is mandatory for successful completion of the Dental
Assisting Program. Students must complete the DVC degree requirements before graduation to be eligible for the Dental
Assisting National Board Examination and Licensing Examinations held by the Dental Board of California.
Directions: This form is to be completed by the applicant. Enter the course number, course title, college where the
course was taken, the date (semester) the course was completed, or identify the semester you plan to take the course.
Substitutions for General Education Courses must be approved by Admissions and Records, and are kept on file.
DVC Category/Course
Equivalent
Course #
Course Name
College Where
Course
Was Taken
Date
completed
or planned
Course
Grade
COMM 120 or
COMM 130
PSYCH 101 or
PSYCH 122
BUS 101 or
ENGL 117 or
ENGL 118 or
ENGL 122
Applicant's Certification
I hereby certify that I have personally read and completed the above worksheet. All information provided can be verified by transcripts or a
Degree Audit Report. I accept complete responsibility for requesting all required official documents.
Signature
Date
International Coursework
Foreign college transcripts need to be translated/evaluated by a foreign evaluation services that is a NACES member. A list
of NACES approved credential evaluators is available at www.naces.org. Evaluation must include a course-by-course report
with semester unit equivalencies that distinguish between upper-and lower-division coursework, and include letter grades.
If foreign coursework is to be used to satisfy a DA requirement, catalog descriptions will be required to show course
equivalencies. English coursework taken at a foreign college will not equate to English 122. The official, evaluated
transcript must be included in your application packet.
Diablo Valley College Dental Assisting Application 2019
Page 7 of 7
Rev.: 10/01/2018
2019 Dental Assisting Program Applicant Checklist
Directions: To be completed by applicant and included in application packet. Please use the check boxes below to ensure
that you have included everything in your application packet and that it is complete. Only those pages of the application
packet specified need to be included. We strongly recommend you mail your completed application packet via certified mail,
return receipt requested. Using certified mail will give you the ability to track delivery of your application packet.
Completed application packet can submitted any time during the Fall and Spring semesters prior to
the DENTL-120: Orientation to the Dental Assisting Program.
Please mail to:
Diablo Valley College
Dental Assisting Application
321 Golf Club Road
Pleasant Hill, CA 94523
Applicant Name: ________________________________________________________
(Last Name) (First Name)
Other Name(s) Used:_____________________________________________________
£ Dental Assisting Program Applicant Check List
£ Dental Assisting Application including applicant’s signature
£ Worksheet for Certificate of Achievement in Dental Assisting including applicant’s
signature
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

DA Application 2019-2020 - DA Application 2019-2020

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 16 February 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document