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Health Sciences Dental Hygiene Program
Pre-Enrollment Policy Acknowledgment Form


This form is to be completed as a part of the Clinical Requirements once you have been invited to enroll in the program.

  • I have reviewed and sought clarification as needed for the referenced policies.   
  • I agree to abide by these policies while enrolled in the Dental Hygiene Program. 
  • I am aware that I must notify my instructor, the Dental Hygiene Director, or Dean of Health Sciences immediately of any situation relevant to these policies as directed in the program policy.   

 I have read and understand the following policies:        

  

 CBC/Criminal Convictions/Drug Screening-Enrolled Students   

 Clinical Requirements    

 Safe Clinical Practice  

Blood-Borne Pathogens Policy  

Technical Standards    

 

    If you need clarification of the above policies, or need to discuss personal issues related to these policies, please contact the Health Sciences and University Programs at 530-339-3606. Staff can provide clarification and answer questions or, if appropriate, can schedule an appointment for you with the Dental Hygiene Director or Dean of Health Sciences. 
     

I understand this acknowledgment will be placed in my student file. 
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