2017 MSU, Mankato Dental Hygiene Traditional Program Application 1

Minnesota State University, Mankato Dental Hygiene Program

Application for Admission Application Deadline: February 1, 2017

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):

E-MAIL ADDRESS: CELL NUMBER: HOME NUMBER:

PERMANENT ADDRESS:

COLLEGE MOST RECENTLY ATTENDED OTHER COLLEGES YOU HAVE ATTENDED

Your application is complete when you submit the following items to the Dental Hygiene Department:

o The completed application form.

o A current copy of your MSU Degree Audit Report (DARS). If you cannot locate this or have not yetreceived this, please contact your dental hygiene advisor.

o The job shadow reflection paper.

o

Application will not be accepted unless all items have been submitted.

○⃝

The completed, signed job shadow form.

For those who have received formal training as a dental assistant, foreign trained dental

therapist, or foreign trained dentist, you must include documentation of training/

licensure.

2017 MSU, Mankato Dental Hygiene Traditional Program Application 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 Credits Grade College (if not MSU)

~ BIOL 220 Human Anatomy ~ CMST 100 or 102 Fund. of Speech Comm. or Public Speaking ~ DHYG 100 Perspectives in Dental Hygiene ~ ENG 101 Composition ~ 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

Credits Grade College (if not MSU) ^ 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; only one is offered in summer. Contact an advisor with questions. Credits Grade College (if not MSU) # 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. Credits Grade College (if not MSU)

FCS 240/242 Nutrition/Nutrition for Healthcare Professionals*HLTH 101 Health and the Environment

* PHIL 120 or 222 Intro to Ethics or Medical Ethics

* DHYG 223 Pharmacology

*

2017 MSU, Mankato Dental Hygiene Traditional Program Application 3

If you have not completed all four science courses at the time of application, please indicate belowwhen you plan to complete the fourth science course; either Chem 106 or Chem 111, Biol 270, orBiol 330.

If you have not completed these courses at the time of application, please indicate below whenyou plan to complete these courses: DHYG 219, DHYG 223, DHYG 225, FCS 242, HLTH 101,PHIL 120 or 222. Note that not all are offered in summer and you will likely need to take thesethe spring semester you apply.

You must submit a new degree audit/DARS report to the Dental Hygiene Department uponcompletion of any 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: http://www.mnsu.edu/admissions/applynow.html

Here is how applications are scored:

1) Overall GPA2) Science GPA, doubled (includes BIOL 220, BIOL 330, BIOL 270, CHEM 106 or 111, DHYG

219, DHYG 223, and DHYG 2253) 1 point for job shadow paper4) 0.5 points for taking CHEM 111 (if used to calculate GPA)5) 0.25 points for formal training as a dental assistant, foreign trained dental therapist, or

foreign trained dentist (must include documentation of training/licensure) 6) 0.25 points for repeat applicant

2017 MSU, Mankato Dental Hygiene Traditional Program Application 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 56001

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.

2017 MSU, Mankato Dental Hygiene Traditional Program Application 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; need to job shadow a dental hygienist. 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.

Bring the Job Shadow Experience form with you and have the hygienist sign it for verification.

Dental Hygiene Application Rubric: % out of 20 x 1

Introduction Sophisticated with clear introduction to content introduced within the body of the paragraph. 1 Good0 Fair/Weak

Conclusion Summarizes content of paper without repeating introduction. 1 Good 0 Fair/Weak

Grammar/Spelling Accurate spelling and punctuation. Consistent with noun-verb agreement throughout thepaper.

3 2 errors or less 2 3-5 errors 1 6 or more errors

Evidence/Support in Body of Paper

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.

11 Strong 7 Moderate 3 Weak

Style of Writing 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.

3 Strong 2 Moderate 1 Weak

Length 1 Paper is typed, double-spaced, and is at least 1 full page, but does not exceed 2 page

maximum length. 0 Paper is not typed, double-spaced, or exceeds 2 pages

2017 MSU, Mankato Dental Hygiene Traditional Program Application 6

Application to MSU-Mankato Dental Hygiene Program Job Shadow Experience

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: