Dental Hygiene Program
Fall 2018 Clinical Requirements Packet

Congratulations!  By now you have been informed by the Health Sciences Office that you have been accepted to the Fall 2018 Dental Hygiene class or are an alternate for the class. It is now time to proceed with fulfilling the clinical requirements All documentation for the Clinical Requirements must be submitted to the Health Sciences Office (Room 8204) as a complete packet in a large envelope by:

Thursday, July 5, 2018
Records will not be accepted separately.

Pre-Enrollment Clinical Requirements checklist is available for you to print and use as a guide in completing all of the processes necessary. If you have been accepted into the Fall 2018 class, complete all Steps (A - G) following the directions here, on the checklist and in the associated policies.

If you have been selected as an alternate to the Fall 2018 class, proceed with Steps A - D and then STOP until directed by the Health Sciences Division. The last steps of the process are time-sensitive and should be completed only when you have been accepted into the class.

We encourage you to start the process by reviewing the clinical requirements for the program and the required immunizations along with the associated clinical requirements policy

Step A - Immunizations - Document on the Immunizations /TB screening Documentation and the 2-Step TB Screening Questionnaire​.

Step B - CPR Certificate - As a dental hygiene student, you will be providing service to patients in a clinical setting and as such are required to be currently certified in Basic Life Support with CPR for adults, children, and infants and tested with two-person rescue. To document current CPR certification, present a copy of your CPR card when submitting your packet. 

Step C - Technical Standards - Dental Hygiene is a physically demanding profession and you must be prepared to meet the technical standards necessary to physically perform the functions. Upon review of the standards, print the Technical Standards Disclosure Form, initialing each of the areas in which compliance with the standard is possible. 

Step D - Confidential Clinical Application - The initial step to completing the criminal background check is to complete the Health Science Program Application for Clinical Practice form. This form discloses to Shasta College (Confidentially) the existence of any criminal issues. While the existence of convictions will not necessarily disqualify you from enrollment, failure to disclose may be considered falsification and will result in the offer of enrollment being rescinded and will be grounds for immediate termination upon discovery at any time during enrollment.

Step E - Physical Examination - The required physical examination must be completed within no more than 6 months prior to entering the program. The results of the physical examination must be documented on the Health Data/Physical Exam form. The front page of the Health Data form is to be completed by you and the back page by your healthcare provider. 

Step F - Tb Screening - The Tb screening results will be documented on the Immunizations Form and on the  2-Step TB Screening & Questionnaire form​

Step G - Criminal Background Check/Drug Screening -  It is important for you to follow the Step-By-Step Instructions for completing the Criminal Background Check and Drug Screening. Proceed with this step ONLY when they have been accepted into the class.

Once you have completed the Clinical Requirements and have the required documentation for each item necessary, the packet may be submitted to the Health Sciences office. The Health Sciences staff secretary will review the materials and verify completion. All materials (with the exception of the actual immunization card) submitted become the property of Shasta College and will not be returned to you. We encourage you to make copies of all the forms and materials submitted for your own records.

Dental Hygiene Program
Clinical Requirements Packet Forms

The links below contain all of the forms you will need to complete your clinical requirements:

Criminal Background Check & Drug Screening Instructions

Pre-Enrollment Criminal
Background and Drug
Screening Policy
Drug Screening, Criminal Background and Criminal Convictions Policy (Enrolled Students)​

Immunization Documentation Form​

2-Step TB Screening & Questionnaire
(New Students)​

Technical Standards Form (Dental)​

Confidential Application for Clinical Practice​

Health Data & Physical Exam Form​


If at any time during the process of preparing for enrollment, you make any changes to your contact information, please notify us immediately.

 Contact Information Change Form