For Admissions use only.
Received By:_________
Return this form to:
Advising Services, Wynn Center (Building 10), room 10-200
Durham Technical Community College
Dental Laboratory Technology Program Admissions Application
Select a Program you wish to pursue:
Associate Degree (includes all certificates) Complete Denture Techniques Certificate
ental Ceramic Techniques Certificat
e C
ast Partial Denture Techniques Certificat
rown and Bridge Techniques Certificat
First Name: __________________________________ Last Name: ____________________________________
Durham Tech Student ID Number: _____________________________ Date: ___________________________________________
ConnectMail Email Address: _______________________________________________________________
NOTE: All official communication from the college is delivered via ConnectMail, including Health Technology admissions
Submit Completed paper application packets to Advising Services beginning February 1 through July 15.
Faxed or Emailed applications are not accepted. Please submit application to:
Wynn Center (Building 10), room 10-200 (Advising Services)
All steps below are required. Please initial that each item is completed.
Enroll at Durham Technical Community College
View College enrollment steps on the website.
______ I am currently admitted to Durham Tech.
Note: If you have not been enrolled with Durham Tech within the last 12 months, you must reapply to
Durham Tech using the CFNC application
______ I have submitted an official transcript(s) from high school and/or college.
Submit to Admissions, Registration, and Records, located in Wynn Center (Building 10), room 10-201
______ I have applied for Financial Aid (recommended but not required).
______ I have attended a ConnectSession (Student orientation)
Note: Prospective students with 12 or more college credit hours transferred to Durham Tech are not
required to attend a ConnectSession, but it is recommended.
Revised 2/24/20 Page 1 of 3
Meet Course Placement Requirements
Students must demonstrate they are college ready in one of the following ways (Initial each item that fulfills this
______ Provide proof of unweighted US high school GPA of 2.8 or higher within the last ten years
______ Transfer credit for English and math (college-level algebra)
______ Provide proof of completion of an associate’s or bachelor’s degree
______ Provide proof of satisfactory scores on ACT, SAT, GED, HiSET, NCDAP, COMPASS, ASSET, or ACCUPLACER
scores within the last ten years
______ Demonstrate mastery on RISE English placement test 2 and RISE Math placement test 2; OR successfully
complete ENG-002 through Tier 2 (grade of P2) & MAT-003 through Tier 1 (grade of P1)
Additional Required Documents:
Students must provide all of the documents listed below with the completed application:
______ I have attached a signed English Language Requirement Form (download from
Health Technologies
admission steps)
______ I have signed the Exposure Control Information (next page)
Statement of Student Responsibility
I verify that I have read all the information regarding admissions to the Dental Laboratory Technology Program, and
understand the steps I must take to qualify for admissions. I understand that it is my responsibility to notify the Student
Information and Records office regarding changes in name, address, or phone number through eForms.
I understand that all official communication from the college is delivered via ConnectMail (only), including Health and
Wellness admissions decisions.
I understand that my Dental Laboratory Technology application will not be accepted if incomplete.
I understand that Dental courses have an expiration date of 5 years. If I do not complete the Associate Degree or
Certificate program(s) within 5 years of starting classes, any courses completed will expire.
Name ______________________________________________ Student ID# _________________________
________________________________________ Date____________________________
Revised 2/24/20 Page 2 of 3
Exposure Control Information:
Durham Tech is committed to the safety of college employees and students and the protection of Durham Tech
College employees and students participating in the Health Technologies and related programs at Durham Tech may be
involved in tasks that include direct contact with blood, body fluids, or tissues. These employees and students should
have a thorough knowledge of the Durham Tech exposure control plan, as well as the exposure control plans at the
clinical sites where they may work or perform clinical rotation. Appropriate protective measures must be taken to
reduce the risk of exposure to infectious disease.
The purpose of the Exposure Control Plan is to significantly reduce the risk of infection for employees with the potential
to be exposed to blood or body fluids. The targeted diseases include Hepatitis B Virus (HBV) and Human
Immunodeficiency Virus (HIV). This plan and noted procedures are in compliance with the Standards of the U.S.
Department of Labor in 29 CFR 1910.1030 Occupational Safety and Health Administration (OSHA), pertaining to
employees who may be subject to occupational exposure to blood borne pathogens. View the plan, and other safety
In order to minimize the potential for the spread of infectious diseases amongst patients and clinical site personnel,
Durham Tech students and employees are highly encouraged to be immunized against and/or tested for infectious
diseases such as mumps, measles, rubella, hepatitis B, and tuberculosis. If you have any questions regarding your
immunization status, a listing of recommended immunizations for health care workers, or program procedures regarding
infection control, please consult your program faculty.
Please review the Student HazCom Right-to-Know and Fire Emergency Evacuation Training document annually.
Additional Information for Dental Students:
Statement of Infection Control in Dentistry, ADA
Occupational Safety & Health Administration OSHA
Guidelines for Infection Control in Dental Health-Care Settings
I have read and understand the Exposure Control Plan.
Name: _________________________________________ Student ID#: _________________________
Signature: _________________________________________ Date: ______________________________
Revised 2/24/20 Page 3 of 3
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome