Dental Hygiene Program -

Application


Albany State University

Darton College of Health Professions

c/o Dental Hygiene Program

2400 Gillionville Road

Albany, GA 31707

 

 

APPLICATION DEADLINE: June 1st

 

 

CONTACT INFORMATION

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

(Optional)

 

 

EDUCATIONAL BACKGROUND

 
 
 
 
 
mm/dd/yyyy
 
 
 
 
 
mm/dd/yyyy
 
 
mm/dd/yyyy
 
 
 
 
 
 
 
mm/dd/yyyy
 
 
mm/dd/yyyy
 
 
 
 
 
 
 
mm/dd/yyyy
 
 
mm/dd/yyyy
 
 
 

 

OBSERVATIONAL HOURS


A minimum of 16 hours must be completed before June 1 in two separate general dentistry offices/facilities. Please summarize your observational hours as indicated below. Be sure to include the verified/signed documentation of hours with the application. You should observe in professional attire and professional conduct. Observation hours are considered applicable for a period of 2 years.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

Required Documents Upload



PLEASE USE THIS SECTION TO ATTACH THE FOLLOWING REQUIRED DOCUMENTS:




Please be sure to attach and upload the following forms listed below. Your application process may be delayed if these forms are not attached!





Observation Hours Form (minimum 16 hours required)


• The Observational Hours Form within this packet is required. It must be signed by a dentist or registered dental hygienist in the facility.



• All hours must be completed prior to the application deadline of June 1.




TEAS Score Report


• Include an unofficial copy of your TEAS Score Report.



• TEAS information can be found in the “TEAS Information” section of this application.




Hand-Written Essay (Word / PDF document acceptable)


• No specific length is required.




Completed Program Application, Pages 9 & 10 (Mailed or Hand-Delivered Before the Deadline of June 1)


• Sent as certified mail if you want confirmation of receipt.




Letter of Acknowledgement of Pre-Admission Orientation


• Include your letter of acknowledgement that you understand and will attend the mandatory orientation in late summer.


• This will be available for internet viewing for students located over a 60-mile radius off campus.




Copy of Unofficial Transcripts (if other than ASU)




Copy of Degree Obtained




 
Drop your files here
 
 
 
 
 
 
 
 

 

LETTER OF ACKNOWLEDGEMENT OF DHYG ADMISSION ORIENTATION


In the case that I, (your name), am accepted into the Dental Hygiene Program beginning Fall Semester (indicated below), I understand that my attendance of the mandatory Dental Hygiene Admission Orientation is necessary to keep my seat in the program.


This orientation will be held during late summer, before fall classes begin. It will be help via Webex and is mandatory that I attend this session. I understand that if I do not attend or view this orientation, then my seat in the program will be forfeited. I understand that this orientation is only intended for me, my parents, financial supporters of my education, and/or spouse. Specific details of time, date, and location will be announced when and if I am accepted.


By signing this Letter of Acknowledgement, I agree that I have read the ASU Dental Hygiene Application and agree with the criteria stated within the application.

 
 

Please type in your First and Last Name.

 
 
mm/dd/yyyy
 

 

SIGNATURE

 
 

Please type in your First and Last Name.

 
 
mm/dd/yyyy
 

 

Personal Identifiable Information (PII) Notice:


All personal data and special categories of sensitive personal data collected or processed by Albany State University (ASU) must comply with the ASU Cybersecurity Program Plan, as authorized by the Board of Regents Policy Manual Section 10.4 Cybersecurity:


https://www.usg.edu/policies


Anyone suspecting his or her sensitive personal data has been exposed to unauthorized access, report your suspicion to:


LegalAffairs@asurams.edu


Otherwise, questions concerning GDPR can be forwarded to LegalAffairs@asurams.edu. Typing your name in the box below and submission of this application provides consent to and acknowledgment of the ASU Data Security and Privacy Policy.

 

Please check the box below to indicate that you have read and understood the PII policy above.

 

 

APPLICATION DEADLINE: June 1st

 

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.