Fill - Free fillable Dental Laboratory Technology Program Admissions Application (Durham Technical Community College) PDF form

For Admissions use only.

Received By:_________

Return this form to:

Date:__________________

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

☐ D

ental Ceramic Techniques Certificat

e ☐ C

ast Partial Denture Techniques Certificat

☐ C

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

decisions.

APPLICATION DEADLINE: July 15

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)

CHECKLIST:

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

requirement):

______ 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# _________________________

Signature

________________________________________ 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

property.

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

information.

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

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

Dental Laboratory Technology Program Admissions Application (Durham Technical Community College)

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank Dental Laboratory Technology Program Admissions Application (Durham Technical Community College) Form

Related forms

Fillable Dental Laboratory Technology Program Admissions Application (Durham Technical Community College)

Fill Online, Printable, Fillable, Blank Dental Laboratory Technology Program Admissions Application (Durham Technical Community College) Form

Related forms

First 20 documents completely FREE!