DENTAL HYGIENE PROGRAM
UNOFFICIAL PREREQUISITE WORKSHEET
Name:
Address:
City, State, Zip:
Date:
Phone:
Email:
Intended Year of Entry (classes start in mid-August):
PLEASE READ THE FOLLOWING DIRECTIONS CAREFULLY:
•
•
•
• A single course may not be used in more than one area.
• For credit to be counted, it must be 100 level or higher.
• Please save this evaluation for your records.
Do NOT use PASS/FAIL coursework.
Grades of “C” or better only, “C-“ or lower not acceptable.
Science courses should be taken within the last 7 years.
NATURAL SCIENCES: 14 semester credits or 20 quarter credits (Quarter Credits ÷ 1.5 = Semester Credits)
Must include:
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•
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Chemistry with lab – 1 course
Microbiology – 1 course
Human Anatomy and Physiology with lab – Full year-long series (all parts of the series should be taken at the same institution)
Dept. & No.
Semester
Credits
Course Title
Grade
Repeated?
Y/N
Date
Completed
To Be
Completed
Institution
COMMUNICATION: 6 semester credits or 8 quarter credits (Quarter Credits ÷ 1.5 = Semester Credits)
Must include:
• English Composition or Writing – 1 course
• Public Speaking or Interpersonal Communication – 1 course
• English/Writing/Communication Elective – 1 course**
Dept. & No.
Semester
Credits
Course Title
Grade
** If needed to complete required credits.
Repeated?
Y/N
Date
Completed
To Be
Completed
Institution
SOCIAL SCIENCES: 6 semester credits or 8 quarter credits (Quarter Credits ÷ 1.5 = Semester Credits)
Must include:
• Psychology – 1 course
• Sociology – 1 course
• Psychology/Sociology Elective – 1 course**
Dept. & No.
Course Title
Semester
Credits
** If needed to complete required hours.
Grade
Repeated?
Y/N
Date
Completed
To Be
Completed
Institution
MATHEMATICS: 3 semester credits or 3 quarter credits (Quarter Credits ÷ 1.5 = Semester Credits)
Must include:
• College level mathematics – 1 course
Dept. & No.
Course Title
Semester
Credits
Grade
Repeated?
Y/N
Date
Completed
To Be
Completed
Institution
NUTRITION: 2 semester credits or 2 quarter credits (Quarter Credits ÷ 1.5 = Semester Credits)
Dept. & No.
Course Title
Semester
Credits
Grade
Repeated?
Y/N
Date
Completed
To Be
Completed
Institution
SPANISH: 3 semester credits or 3 quarter credits (Quarter Credits ÷ 1.5 = Semester Credits)
Dept. & No.
Course Title
Semester
Credits
Grade
Repeated?
Y/N
Date
Completed
To Be
Completed
Institution
Semester
Credits
Grade
Repeated?
Y/N
Date
Completed
To Be
Completed
Institution
MEDICAL TERMINOLOGY: 1 course
Dept. & No.
Course Title
HUMANITIES: 8 semester credits or 12 quarter credits (Quarter Credits ÷ 1.5 = Semester Credits)
Any combination of classes in:
• Humanities, Ethics, History, World Languages, Literature, Philosophy, Communications, Art, Music, Theatre and/or Religion
Dept. & No.
Course Title
Semester
Credits
Grade
Repeated?
Y/N
Date
Completed
To Be
Completed
Institution
OVERALL CREDITS: a minimum of 48 semester credits or 72 quarter credits are needed prior to entry
I acknowledge that I will need to complete a minimum of 48 college level semester credits or 72 quarter credits,
including the above prerequisites, prior to entrance into the program.
 Yes
 No
For an unofficial evaluation of your coursework please send this filled out
worksheet and your unofficial transcripts to:
FAX: (503) 352-7290
EMAIL:
gradadmissions@pacificu.edu
MAIL: Pacific University Office of Admissions | 190 SE 8th Avenue, Ste. 181 | Hillsboro, OR 97123
Evaluation Legend:

X
-course approved
-course not acceptable
ok
ok in a box
-course approved but not completed
-section approved and complete