Program Policy Agreement
Dental Assisting Program
1. Receipt of Indian Hills Community College Dental Assisting Program Student Handbook
I have received a copy of the student Program Policy Manual. I understand I am responsible to read the
Dental Assisting Program Student Handbook completely and will be held accountable for complying with
all policies and procedures of the Dental Assisting Program. It is my responsibility to ask for clarification
from the Program Director regarding any policy or procedure I do not understand. I will read new policies
or procedures that are issued by the program. I understand that I am also responsible to read and comply
with the general student policies of IHCC.
2. Responsibility for Conduct and Actions as a Dental Assisting Student
I understand that having been admitted to the IHCC Dental Assisting Program, I am held responsible for
my conduct and actions as a Dental Assisting student. I understand that breech of IHCC or the Dental
Assisting Program policies or the Dental Assisting code of ethics may result in consultation, and perhaps
probation, suspension or dismissal depending on the nature of my actions. I understand that client safety,
privacy and dignity are of the highest priority in Dental Assisting.
3. Titles VI and XII of the Civil Rights Act of 1964 and Title IX of the Education Amendments of 1972
I understand that IHCC complies with Titles VI and XII of the Civil Rights Act of 1964, Title IX of the
Education Amendments of 1972, and other federal laws and regulations; and does not discriminate on
the basis of race, color, national origin, sex, age, religion, handicap, or status as a veteran in any of its
policies, practices, or procedures. This includes, but is not limited to admissions, employment, financial aid
and educational services. I understand I may follow the grievance procedure guidelines described in this
handbook if I wish to file a complaint.
4. Medical Treatment
I understand I am responsible for payment for any medical treatment that may be necessary and is not
covered under the provisions of the Iowa Code.
5. Computer User Agreement
As a condition of using the IHCC computer equipment, I agree not to use the equipment to duplicate
copyrighted software in violation of its end user’s license agreement, whether it is my personal copy or is
owned by IHCC. I assume liability for any copyright infringements caused by me.
Name:
Signature: Date:
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