DelMarCollege DentalHygieneProgram ProgramData/ApplicationSheet

DateApplicantcompletedapplication: (PleasePrintlegiblyinblackink)

Name (Last)

(First)

(Middle)

Othernamespreviouslyused:

DelMarStudentI.D.# MailingAddress: Address HomePhone,CellPhone&AreaCode: EMailAddress:

Education:HighSchoolGraduate:

orS.S.#

GED:

City,State,ZipCode

Listallcollegesand/oruniversitiesattended: Dateattended Dateattended Dateattended Previousdentalorhealthcarebackground: R.D.A C.D.A. Other LevelofEducationcompleted: A.A./A.S./A.A.S B.A./B.S. M.A./M.S. Other
HaveyoutakenaPlacementtest?THEA Date WeretestscoressenttoDelMarCollege? Yes ACT Date No SAT Date

COMPASS Date

AdmissionRequirementsCompleted: HaveyoucompletedtheDelMarCollegeapplicationthroughtheAdmissions/RegistrarsOfficeor www.applytexas.org Datesent: Submittedonline: Haveofficialhighschool/GEDandcollegetranscriptsbeenforwardedtoDelMarCollege Admissions/RegistrarsOffice: Datesent: HaveofficialcollegetranscriptsbeenforwardedtotheDentalHygieneProgramoffice? Datesent:

Page2 DentalHygiene Data/ApplicationSheet Reminder:SendofficialcopiesofallacademicinformationalongwiththreeRecommendationforms totheDentalHygieneProgram.FailuretosubmitallappropriatedocumentationtotheDentalHygiene ProgrambytheMarch1stdeadlinewillconstituteanincompleteapplication. DentalHygieneCoRequisiteCourses

CoRequisiteCourse College Grade Semester &Year

BIOL2401HumanAnatomy&PhysiologyI CHEM1406BasicChemistry BIOL2402HumanAnatomy&PhysiologyII BIOL2420Microbiology&Clinical Pathology ENGL1301CompositionI SOCI1301IntroductorySociology PSYC2301GeneralPsychology SpeechElective Humanities/VisualorPerformingArts Elective Humanities/VisualorPerformingArtsElectivecanconsistofallENGL2300 Literaturecourses;allARTS courses;allDRAMcourses;allPHILcourses;allHUMAcourses;allMUSIcourses;andDANC2303Dance Appreciation PleasespecifyifyouarecurrentlyenrolledorwillbeenrolledintheSpringsemesterinanyofthe abovecoursestoreceivepropercredit.

ItistheAPPLICANTSRESPONSIBILITYtoverifythathis/herfileiscompletein theDepartmentofDental&ImagingTechnologyOffice,WestCampus,Health ScienceBuilding#2,Room130.Contact(361)6982858orpmartin@delmar.edu.

StudentsSignature:
MailingAddress

Date:

PhysicalAddress

DelMarCollege(EastCampus) DelMarCollege(WestCampus) Dental&ImagingTechnologyDepartment Dental&ImagingTechnologyDepartment DentalHygieneProgram DentalHygieneProgram 101Baldwin HealthScience#2,Room130 CorpusChristi,Texas78404 4101OldBrownsvilleRd. CorpusChristi,Texas78405 (361)6982858 (361)6982811fax NondiscriminationPolicy:DelMarCollegedoesnotdiscriminateonthebasisofrace,color,sex,age,nationalorigin,religion, handicap/disability,oranyotherconstitutionallyorstatutorilyimpermissiblereason.Thisshallincludepersonswithdisabilities. Revised:09/23/2009