Cabrillo College Dental Hygiene Program Associate in Science Degree
APPLICATION FOR ADMISSION
PREREQUISITES
After prerequisites are completed, an application may be submitted at any time throughout the year.
Due to rigors of dental hygiene core courses, it is strongly recommended, but not required, that ALL general
education (GE) requirements be completed prior to starting the program.
o All science prerequisite courses must be completed within the previous 6 years.
o “In Progress” prerequisites are not accepted.
o Required combined science grade point average (GPA) must be 2.7 or higher (BIO 4, BIO 5, BIO 6
and CHEM 30B).
o Required English Grade must be a “C” or better (ENGL 1A, 1AH, 1AMC, 1AMCH).
o Required GE coursework must be a “C” or better in all courses.
NEW STUDENTS-APPLY TO CABRILLO COLLEGE AND OBTAIN A STUDENT IDENTIFICATION (ID) NUMBER
A Cabrillo College application is needed in addition to a dental hygiene program application.
A Cabrillo College student ID number is required on the dental hygiene application form. This is a unique, 7- digit
number assigned to all Cabrillo College students.
o If you have never attended Cabrillo College, go to: Cabrillo College Application Information to apply.
After your application is accepted, log on to Web Advisor to retrieve your Student ID number.
Allow approximately one week to complete this process.
A COMPLETE APPLICATION PACKET MUST INCLUDE THE FOLLOWING:
1. Application Forms (3 pages)
2. Transcripts documenting ALL completed college coursework. Do not send unofficial transcripts, photocopies,
or transcripts with opened envelopes.
o If you attended Cabrillo: Print two (2) Web Advisor unofficial transcripts using “My Course History.”
o If you attended another college/university: Contact the Admissions and Records office(s) of each
college/university to request two (2) sealed official transcripts and allow up to 6 weeks to receive your
transcripts. Expect to pay fees for this service.
o AP Courses and International Transcripts must be evaluated by a counselor. Please visit the Cabrillo
College Academic Counseling web site to make an appointment with a counselor.
o Falsification of any part of your application or transcripts will be cause for termination of the
application process and/or dismissal from the program.
3. Mail by U.S. Postal Service Certified Mail and Return Receipt.
o All required items must be in the same envelope.
o Return Receipt is the only confirmation you will receive to verify that your application has been
delivered to Cabrillo. It will also confirm the application postmark date. Retain this receipt for
your records.
o Send To:
Cabrillo College
Dental Hygiene Attn: Program Coordinator
6500 Soquel Drive
Aptos, CA 95003
Incomplete packets may affect your application status.
After applying – Keep in touch! Applicants are required to inform the DH Program of any changes in personal
information including name, address, phone or email within 30 days. Make changes by completing the online DH
Contact Update Form. This contact information needs to be updated in Web Advisor as well. The majority of
program correspondence will be via email.
May4_2016– Dental Hygiene Instructions and Application
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Cabrillo College Dental Hygiene Program Associate in Science Degree
APPLICATION FOR ADMISSION
Please Print CLEARLY in Blue or Black Ink ONLY
Legal Last Name
Legal First Name
Middle Name (if applicable)
 Female
Date of Birth
 Male
Cabrillo Student ID#
Name(s) you prefer to be called (e.g. nickname)
Other name(s) used (e.g. maiden name)
Mailing Street Address
City
State
Zip
Email
(
)
Home Telephone
(
)
(
Mobile Telephone
COMPLETED COURSEWORK
)
Message Telephone
Continue on separate page if necessary.
NAME OF COLLEGE OR UNIVERSITY
DATES ATTENDED
PREREQUISITES
These courses are required for the Associate of Science degree. Questions regarding prerequisites, graduation requirements, and
transferability of course work should be directed to the Dental Hygiene Counselor. Counselors are not able to evaluate course
transferability by phone or via correspondence. Candidates must make a personal appointment with the Dental Hygiene Counselor in order
to start the evaluation process. Please see the Cabrillo College Associate in Science Degree Dental Hygiene Program Requirements for
Graduation Counseling Form / Worksheet online at http://www.cabrillo.edu/publications/catalog/current/departments/dh.pdf
Have you completed the prerequisites below? Yes  No (If Yes, please complete the table below. If No, you must complete
prerequisites before applying.)
Prerequisite Requirements
Actual Course Taken
Units
Grade
Sem./ Qtr
& Year
College / University
BIO 4: Human Anatomy
BIO 5: Human Physiology
BIO 6: Introduction to Microbiology
CHEM 30B: Intro Organic Chemistry &
Biochemistry for Health Occupations
ENGL 1A/1AH/1AMC/1AMCH: English
Composition
Prerequisites may also be used to satisfy appropriate general education areas. Due to the rigorous academic nature of the Dental Hygiene
Program it is advisable to complete the general education requirements for the Associate Degree, before entering the program. The DH
program follows the academic policies and procedures listed in the Cabrillo College Catalog and DH Student Policy Handbook.
MATH 152, or MATH 152A and MATH 152B or MATH 142 or MATH 142A and MATH 142B or equivalent is a prerequisite for CHEM 30A;
CHEM 30A is a prerequisite for CHEM 30B*, BIO 5 and BIO 6.
May4_2016– Dental Hygiene Instructions and Application
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Cabrillo College Dental Hygiene Program Associate in Science Degree
APPLICATION FOR ADMISSION
Last Name
First Name
Middle Initial
GENERAL EDUCATION REQUIREMENTS
This A.S. Degree requires completion of required Dental Hygiene Courses and a 21-unit general education pattern (see Cabrillo College
transfer and articulation web site), and contained in the following areas. Please click here to see the AS DH Program Worksheet for detailed
listing of required courses for graduation.
At this time general education, A.S. Degree requirements do not have to be completed prior to application and admission to the dental
hygiene program. However, due to the rigorous nature of the core coursework, it is strongly recommended that they be completed prior
to the start of the program with a minimum GPA of 2.00 for these courses.
Due to Commission on Dental Accreditation (CODA) requirements for an Associate Degree in Dental Hygiene some General Education
courses are specific to dental hygiene, see table below.

Math Requirement for Graduation:
Intermediate Algebra (MATH 152) or mathematics placement test score indicating eligibility for a mathematics course beyond the
level of MATH 152, or completion of a higher-level course with a grade of C or better, or completion of a Bachelor’s degree or higher
from an regionally accredited U.S. college or university.
GE Requirements
Actual Course Taken
Units
Grade
Sem/ Qtr
& Year
College / University
AREA A1: Met by English 1A/1AH/1AMC/1AMCH
AREA A2: Public Speaking, Honors Public Speaking or
Group Discussion
AREA B: Human Anatomy, Human Physiology or
Microbiology (Met by Science Prerequisite above)
AREA C: Any course in AS Degree Area C: Arts &
Humanities
AREA D: General Psychology 
AREA D: US History OR Political Science

AREA D: Introduction to Sociology (SOC 1) or Social
Problems (Soc 2)
AREA E: Nutrition 
MULTICULTURAL: A course that studies a nonwestern society or culture or ethnic minority in the
US.
MATH: Intermediate Algebra
Courses with this symbol () are required by the Committee on American Dental Accreditation (CODA)
May4_2016– Dental Hygiene Instructions and Application
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Cabrillo College Dental Hygiene Program Associate in Science Degree
APPLICATION FOR ADMISSION
Last Name
First Name
Middle Initial
MINIMUM PHYSICAL AND NON-PHYSICAL STANDARDS for DENTAL HYGIENE STUDENTS
To Be Completed By Dental Hygiene Students and Returned with the Application for Admission
In the interest of your own personal safety, the safety of patients and the potential liability to both the college and clinic, there are significant
requirements that must be met before your admission to the program can be finalized. The attendance requirements and stamina demands
on the dental hygiene student requires that they be in good physical and mental health. Please read this form carefully and initial each
technical standard if you can comply with the standard. When complete, please sign, date and return the original to the Dental Hygiene
program with your application. Upon acceptance, a healthcare provider’s approval and signature will be required.
Issue
Description
Standard
Examples of Necessary Action
Initials
(Blue Ink)
BEHAVIORAL
Emotional & mental stability
Functions effectively under stress and
time constraints.
Flexible, concern for others. Ability to provide
safe dental care environment with multiple
interruptions and noises, distractions,
unexpected patient needs
COMMUNICATION
Speech, reading, writing and
effective use of English language.
Communication abilities sufficient
for effective interaction in verbal,
nonverbal and written form.
Comprehension and accurate recall of
verbal and written communication.
Interaction with patients, families,
students, instructors, staff effectively
understanding verbal and nonverbal
behavior.
Concisely and precisely explain treatment
procedures, initiate preventive dental care,
interpret patient's response, and document
following ethical and legal guidelines.
CRITICAL &
ANALYTICAL
THINKING
Ability to problem solve
Critical and analytical thinking abilities
sufficient for clinical judgment
Identify cause-effect relationships in clinical
situations, develop dental care plans
HEARING
Use of auditory sense
Auditory ability sufficient to monitor
and assess health needs.
Ability to hear and verbally respond to patient
questions and directions from instructors,
students, staff in person or over the phone,
hear blood pressure.
INTERPERSONAL
Ability to relate to others
Abilities sufficient to effectively
interact with individuals, families,
groups & colleagues from a variety of
social, emotional, cultural, intellectual
& economic backgrounds Identify
needs of others.
Establish rapport with patients, families, and
colleagues.
MOBILITY
Physical ability, strength and
stamina
MOTOR SKILLS
Physical ability, coordination,
dexterity
TACTILE
Use of touch
Tactile ability sufficient for physical
assessment, operation of instruments
and equipment.
Perform the required techniques using scaling
and polishing instruments, dental equipment,
syringes, radiographic devices, and sterilizing
equipment.
Use of site
Visual ability sufficient for observation
and assessment necessary in dental
hygiene care.
Perform the required procedures in the oral
cavity, chart identification and recording,
calibrating sterilization and x-ray equipment.
View, evaluate, read and positioning of
radiographic images, techniques and quality.
VISUAL
Physical abilities and stamina sufficient
to perform required functions of
patient oral care.
Gross and fine motor abilities sufficient
to provide safe & effective dental
hygiene care. Concise hand/eye
coordination and spatial acuity.
May4_2016– Dental Hygiene Instructions and Application
Lift, carry or move objects weighing up to 40
pounds. Stand, rotate, push, pull, sit, bend, flex,
squat and torso.
Execute the small muscle hand and finger
motor movements required to safely perform
dental hygiene services
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