Dental Hygiene Program Clinical Requirements Packet

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.

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.

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from enrollment, failure to disclose may be considered falsification and will result in the offer of enrollment being rescinded and will be grounds for immediate termination upon discovery at any time during enrollment.

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

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. 

Information from the Student Data Form​ will be kept on file while you are enrolled in the program. It is your responsibility to notify the Health Sciences office of any changes in your contact information by filling out the contact information change form available on the Health Sciences website.

• User of Electronic Devices Agreement
• Student Honor Contract
• Photography and Publication Release
• Assumption of Risk and Release 

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.

Complete only one of the following tests and the corresponding form:

• Standard PPD - Complete the Tuberculosis Screening form (PDF) and attach the second Tuberculosis screening results within the timeframe above.  

OR

• Quantiferon Gold Blood Test – Complete the Confidential TB Questionnaire form (PDF) with clearance from your physician and attach documentation of a negative Quantiferon Gold Blood Test within the time from applicable to your start semester as specified above.