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ORANGE COUNTY COMMUNITY COLLEGE OFFICE OF ADMISSION
115 SOUTH STREET | MIDDLETOWN, NEW YORK 10940
This form must be filled out by students wishing to be considered for entry into the Dental Hygiene Program in Fall 2012 and
returned to the Admissions Office by February 1, 2012 for consideration.
Fall 2012 Dental Hygiene Program Application
Name (Please print legibly):_________________________________________________ Student ID#: A
Mailing Address:________________________________________________________________
City:_________________________State:_____Zip Code:________ Legal County of Residence:__________________
Phone Number:________________________ E-Mail:______________________________
Date of Birth:_________________
Have you ever been enrolled in a Health Professions program at an Associate’s degree level or higher either at SUNY Orange or
another college? Yes No Program:_______________________________
If yes, did you successfully complete the program? Yes No
Transcripts from all institutions will be reviewed as part of the admissions process. Please list all colleges previously attended:
____________________________________________________________________________________________________________
Academic Requirements:
Admissions Requirements
• High school diploma or GED.
• Eligible to take Freshman English I (ENG 101).
• Eligible to take Intermediate Algebra (MAT 102), or have completed Elementary Algebra (MAT 101) or equivalent with a
2.0 or higher.
• Completed Intro to Biology (BIO 110), Anatomy & Physiology I (BIO 111), or Anatomy & Physiology II (BIO 112), with a
grade of 2.0 or better; High School AP Biology (score of 3, 4, or 5) or a passing grade in the Biology CLEP examination
within 5 years (Spring 2007 semester or later).
• Completed High School Regents Chemistry with a grade of 75 or better; Elements of Chemistry & Physics (CHM 120); or a
college Chemistry course (with a lab) with a grade of 2.0 or better within 5 years (Spring 2007 semester or later).
• Students must attain a minimum cumulative GPA of 2.5.
Department Specific Requirements:
• Submit Dental Hygienist observation form. (16 hour min. with documentation)
• Attendance at a Dental Hygiene department pre-admission orientation in the past three years. At this orientation, students
will receive and sign off on information pertaining to health forms, drug testing, and criminal record policies. Orientation
dates and observation forms are available online at
www.sunyorange.edu/admissions/healthforms.shtml.
Students will be considered for admission into this program based on the completion of all academic and department specific
requirements, highest combination of cumulative GPA and credits completed towards the program (see reverse), observations,
and seats available.
Selection Process
Students must meet all of the above requirements to be considered for admission into the program.
All Dental Hygiene Admissions Requirements must be completed before February 1
st
in order for a student to be considered
for acceptance into the program for the fall semester.
Student Certification and Signature (please check one of the following)
I have attended a pre-Admissions Orientation and completed my observation within 3 years of my planned program start date
(Fall 2009 semester or later).
:
I plan to attend/have attended a pre-Admissions Orientation this year. Include date attended/plan to attend (mo/yr)____________
My signature acknowledges that I have read and accept the admissions requirements listed above, and that all of the information
provided is accurate and complete.
Student Signature Date:
For Office Use Only: Accept _________Alt_______ Checklist_______ Low Cum_______ No Deposit _____ Declined ____
Dept Chair/Designee Signature Date:
Admissions Signature Date:
