Minnesota State University, Mankato Dental Hygiene Program Application for Admission. Application Deadline: February 1, 2016

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1 Minnesota State University, Mankato Dental Hygiene Program Application for Admission Application Deadline: February 1, 2016 Year of catalog/academic bulletin you are following (see degree audit): NAME: Last, First, Middle initial BIRTHDATE: ACADEMIC ADVISOR: MSU-M STAR ID or TECH ID (required): ADDRESS: CELL NUMBER: HOME NUMBER: PERMANENT ADDRESS: COLLEGE MOST RECENTLY ATTENDED OTHER COLLEGES YOU HAVE ATTENDED Application will not be accepted unless all items have been submitted. Your application is complete when you submit the following items to the Dental Hygiene Department: o The completed application form. o o The job shadow reflection paper. o The completed, signed job shadow form. A current copy of your MSU Degree Audit Report (DARS). If you cannot locate this or have not yet recieved this, please contact a dental hygiene advisor. For those who have received former training as a dental assistant, foreign trained dental therapist, or foreign trained dentist, you much include documenation of licensure MSU, Mankato Dental Hygiene Traditional Program Application 1

2 Please indicate the number of credits and letter grade you earned for each of the following courses. If you have not yet completed the course, just leave blank. (~) These courses must be completed prior to applying to the DHYG program ~ BIOL 220 Human Anatomy ~ CMST 100 or 102 Fund. of Speech Comm. or Public Speaking ~ DHYG 100 (waived for transfer students) Perspectives in Dental Hygiene ~ ENG 101 Composition ~ HLTH 321 (only if following catalog/bulletin or older) Medical Terminology ~ MATH 112 (only if following catalog/bulletin or older) College Algebra ~ PSYC 101 Intro to Psychology ~ SOC 101 or 150 Intro to Sociology or Social Problems ~ SOC 202 or STAT 154 (list if other statistics course: ) Introductory Social Statistics or Elementary Statistics (^) Two of these three courses must be completed prior to applying to the DHYG program ^ BIOL 270 Microbiology ^ BIOL 230 or 330 Human Physiology ^ CHEM 111 or CHEM 106 Chemistry of Life Processes (Org. Chem) or Intro to Chem for Allied Health Professions If both Chem 106 and Chem 111 were taken, circle above which one you want to count toward your science GPA; if none circled, we will use Chem 111. (#) One of these two courses should be completed prior to applying to the DHYG program and both must be completed prior to starting the program. If you have not completed at least one of these, you can still apply if you register for both in the spring. Contact an advisor with questions. # DHYG 219/319 Head and Neck Anatomy # DHYG 225/325 Oral Anatomy (*) These courses must be completed prior to starting the DHYG program. Leave blank if not yet taken. * DHYG 223 Pharmacology * * FCS 240/242 Nutrition/Nutrition for Healthcare Professionals HLTH 101 Health and the Environment * PHIL 120 or 222 Intro to Ethics or Medical Ethics 2016 MSU, Mankato Dental Hygiene Traditional Program Application 2

3 If you have not completed all four science courses at the time of application, please indicate below when you plan to complete the fourth science course; either Chem 106 or Chem 111, Biol 270, or Biol 330. If you have not completed these courses at the time of application, please indicate below when you plan to complete these courses: DHYG 219, DHYG 223, DHYG 225, FCS 242, HLTH 101, PHIL 120 or 222, You must submit a new degree audit/dars report to the Dental Hygiene Department upon completion of any these courses taken after Fall semester. Course Name and Number Planned Semester You cannot be considered for admission into the Dental Hygiene Program until you have been accepted to Minnesota State University, Mankato. Applications for admission to Minnesota State University, Mankato must be done separately Link to university online application instructions: Here is how applications are scored: Overal GPA Science GPA, doubled (includes BIOL 220, BIOL 330, BIOL 270, CHEM 106 or 111, DHYG 219, DHYG 223, and DHYG 225) 1 point for job shadow paper 0.5 points for taking CHEM 111 (if used to calculate GPA) 0.25 points for former training as a dental assistant, foreign trained dental therapist, or foreign trained dentist (must include documentation of licensure) 2016 MSU, Mankato Dental Hygiene Traditional Program Application 3

4 PLEASE READ THE FOLLOWING STATEMENT Due to the nature of the clinical experiences in the dental hygiene program, students will be participating in a work environment that has the potential of exposure to blood borne pathogens. All students accepted into the dental hygiene program are provided with written policy and instruction on infection control protocol to reduce the risk of disease transmission. The program complies with all institutional, local, state and federal policies. Policies and procedures of the dental hygiene program s infection control protocol are available to all applicants upon request. Other work-related disorders associated with the practice of dental hygiene could result from repetitive activities and exposure to high decibel sounds. Advancements in design and technology in the profession are continually evolving to minimize these effects. PRINT NAME SIGNATURE DATE Your application and supporting documents can be mailed to: Dental Hygiene Department 3 Morris Hall, MSU-M Mankato, MN You may also personally deliver your application and supporting documents to the Administrative Assistant of the Dental Hygiene Department in the lower level of Morris Hall. NOTE: The college/university is asking you to provide information, which includes private and/or confidential information under state and federal law. The college/university is asking for this information in order to process your application. You are not legally required to provide the information the college/university is requesting; however the college/university may not be able to effectively process your application if you do not provide sufficient information. With some exceptions, unless you consent to further release of private information, access to this information will be limited to school officials, including faculty who have legitimate educational interests in the information. Under certain circumstances, federal and state laws authorize release of private information without your consent: to other schools in which you seek or intend to enroll, or are enrolled, if you are first notified of the release; to federal, state, or local officials for purposes of program compliance, audit, or evaluation; as appropriate in connection with your application for, or receipt of, financial aid; to your parents, if your parents claim you as a dependent student for tax purposes; if the information is sought with a subpoena, court order, or otherwise permitted by other state or federal law, and to an institution engaged in educational research or accrediting agency. Minnesota State Colleges and Universities abide by the provisions of Title IX, federal legislation forbidding discrimination on the basis of sex and by all other federal and state laws regarding equal opportunity. This document can be made available in alternate formats, such as large print or cassette tape, upon request. The curriculum listed in this document is subject to change MSU, Mankato Dental Hygiene Traditional Program Application 4

5 The Job Shadow Experience As part of your application to the Dental Hygiene Program, you will need to complete a 4-hour job shadow experience. Following your job shadow experience, select three characteristics/traits the hygienist possessed that you believe you possess, and describe why these are important, using evidence from your past experiences. The reflection paper should be 1-2 pages in length and double-spaced. Use the rubric below to help write your paper. Take the included form with you and have the hygienist sign it for verification. Dental Hygiene Application Rubric: Introduction Conclusion 1% Weak Grammar/Spelling Evidence/Support in Body of Paper Style of Writing Length Sophisticated with clear introduction to content introduced within the body of the paragraph. 5% Strong 3% Moderate 1% Weak Summarizes content of paper without repeating introduction. 5% Strong 3% Moderate Accurate spelling and punctuation. Consistent with noun-verb agreement throughout the paper. 15% 2 errors or less 10% 3-5 errors 5% 6 or more errors Professional, substantial, well-developed ideas. Three areas observed during job shadow experience related to applicant s capabilities. Provides evidence of personal characteristics/qualities needed for dental hygiene. 50% Strong 35% Moderate 20% Weak Information in effective order, paragraphs, topic sentences, and transitions help paper flow smoothly. Precision and variety in sentence structure and word choice are apparent. Strong sentences that omit extra words such as that and the when not needed. No contractions are used. Pronouns such as it are avoided. 20% Strong 15% Moderate 10% Weak 5% Paper is typed, double-spaced, and is at least 1 full page, but does not exceed 2 page maximum length. 1% Paper is not typed, double-spaced, or exceeds 2 pages 2016 MSU, Mankato Dental Hygiene Traditional Program Application 5

6 Application to MSU-Mankato Dental Hygiene Program Job Shadow Experience Applicant s Name: Date of Visit: Office Name: Office Address: Office Phone Number (with area code): Dentist s Name: Hygienist s Name: Please list procedures/duties observed as well as traits the hygienist possessed that you believe made him/her a good dental hygienist: Hygienist s Signature: Applicant s Signature: 2016 MSU, Mankato Dental Hygiene Traditional Program Application 6