Full-time Day Program
Submit completed application to the Registrar’s office
PALM BEACH STATE COLLEGE at LAKE WORTH
4200 Congress Avenue
Lake Worth, FL 33461-4796
Web Site: www.palmbeachstate.edu/dentalhealth.xml
An Equal Opportunity Institution
DEADLINE: July 1, 2012
About the Program
Accredited by the American Dental Association, Commission of Dental Accreditation, students enrolled in the Dental Assisting Program work directly with community dentists providing treatment on patients in our modern dental facility at the Lake
Worth Campus. This ten month program begins in the fall term of each year and is offered as a daytime program only. Nineteen (19) college credits and twenty-five (25) vocational-educational credits comprise this PSAV Program. Upon completion graduates are awarded the Florida Expanded Functions Certificate ( Florida Statute Chapter 466-Rule 64B5, Florida
Administrative Code), a Certificate of Completion, and are eligible to take the Dental Assisting National Board to become
Certified Dental Assistants.
Program Begins: August 23, 2012
Program Length: 1144 contact hours, approximately 10 months in length
Program Schedule: Full-Time Day Program, Monday through Friday, approximately 8:00 a.m.-5:00 pm.
What are the costs for the program?
Tuition Fees
Dental Assisting
Tuition
Textbooks
Uniforms
Miscellaneous
Total (estimate)
$4000.00
(19 College Credits and
25 Non-Credit Hours)
$600.00
$200.00
$800.00
$5600.00
Financial Aid is available for this program and it is recommended that you apply early. You can apply online at www.palmbeachstate.edu/FinancialAid.xml
. Also, there are a limited number of scholarships through the Palm Beach State
College Foundation. Currently, all Foundation Scholarships require the FAFSA, which may be filed on-line at www.fafsa.ed.gov
.
Toll-free “help line” 8:00 – midnight 1-800-433-3243.

The following criteria must be completed and the relevant documentation submitted by July 1, 2012. These criteria are established as the minimum to be eligible for placement in the selection pool. Meeting minimum criteria for selection does not guarantee admission to the Dental Assisting program. Final selection will be based on the applicant pool and space available.
If a student is selected and does not enter the program or is not selected, the applicant must reapply and is not guaranteed acceptance in any subsequent selection process. PLEASE NOTE: You must activate your student e-mail account as communication regarding your application status including acceptance and denial documentation will ONLY be sent to your Palm Beach
State e-mail account. To activate your account go to www.palmbeachstate.edu/pantherweb.xml
, sign in, and go to the
My.PalmBeachState Email link and follow the instructions.
1.
PALM BEACH STATE COLLEGE APPLICATION
First-time Palm Beach State College Students: Submit a completed Palm Beach State College general credit application at http://www.palmbeachstate.edu/admissionsapplications.xml
and pay the appropriate fee by the deadline date. New students will be assessed a $30 nonrefundable fee. International (F-1/M-1) students will be assessed a $75 nonrefundable application fee. Be sure to insert your current and active email address where r equested; be specific regarding your program of study. Once submitted, a confirmation page with conditions of admission will be sent to the e-mail address provided in the college application. Print the confirmation page and follow the instructions within. Applicants must also submit the program application contained in this packet and submit to the Admissions office.
Non first-time Palm Beach State College Students: Must complete the program application in this packet and submit to the Admissions office.
2.
COMPLETE DENTAL ASSISTING APPLICATION
In addition to the Palm Beach State College general application, the applicant must also submit the program application, which can be located at www.palmbeachstate.edu/dentalhealth.xml
.
There is a $10 non-refundable processing fee due with each Dental Assisting Program application. Submit a paid receipt for this processing fee along with a Palm Beach State College Dental Assisting Program application to the Admissions Office.
3.
ACADEMIC HIGH SCHOOL DIPLOMA OR GED
Official transcripts must be submitted to the Admissions Office proving a standard high school diploma, GED, or validated foreign equivalent. Transcripts are considered official if sent directly to Palm Beach State College from the previous institution or be hand-delivered in a sealed envelope sealed by the issuing institution All applicants – new, current, and college transfer students - must have their official high school or GED transcript on file at the college. You may download the transcript request form from our website at www.palmbeachstate.edu/transcripts.xml
. Students who received a
Florida GED can request their scores using the downloaded form at www.palmbeachstate.edu/transcripts.xml
. Transcripts must be on file at the College Admissions Office in Lake Worth by deadline date.
4.
COLLEGE TRANSCRIPTS
Official college transcripts (transcripts are considered official if sent directly to Palm Beach State College from the previous institution or be hand-delivered in a sealed envelope sealed by the issuing institution) from ALL post-secondary institutions attended must be submitted. You may download the transcript request form from our website at www.palmbeachstate.edu/transcripts.xml
. All post-secondary records from out of the country must be submitted with a commercial evaluation. If you have attended college, we still require proof of a standard high school diploma, GED or validated foreign equivalent. Commercial evaluation of foreign transcripts must be conducted by approved evaluators listed at www.palmbeachstate.edu/transcripts.xml
. A minimum 2.0 cumulative college GPA is required to be eligible for consideration in the selection process.
5.
TEST SCORES ARE VALID FOR TWO (2) YEARS: a.
TABE TEST: All students must take the Test of Adult Basic Education (TABE), Survey, Level A, prior to the start of the dental assistant program. A score at least at the 12 th grade competency level in all parts of the examination must be mastered in order to graduate the program and receive the certificate of completion. Your scores are valid for two years. The Student Learning Center (SLC) at each campus location provides TABE remediation courses for students who need additional skills to pass the TABE test. For more information, please call 561/868-3795.
2

b.
TABE Exemptions: Students with an A.A. A.S., or A.A.S degree or higher; students who have successfully completed the College Level Academic Skills Test (CLAST); or students who have already met the minimum cut scores, within the past two years, on the FCELPT (CPT), SAT1 or ACT-E, are exempt from the exam. Documentation required.
6.
SELECTION:
Acceptance will be determined in order of receipt of:
1. Palm Beach State College general admission application form and fee ($30.00), if first time PBSC student
2. Dental Assisting application and fee ($10.00)
3. Official high school transcript showing proof of graduation OR official scores showing completion of a U.S. GED
certificate
4. Official transcripts from all colleges/universities
NOTIFICATION of ACCEPTANCE
Your criteria for selection can be viewed at www.palmbeachstate.edu/pantherweb.xml
under Limited Access Application through following steps:
After submitting your application:
1.
Go to www.palmbeachstate.edu/pantherweb.xml
.
2.
Log on using your Palm Beach State student ID number and pin.
3.
This takes you to your student PantherWeb page.
4. Click on “Limited Access Application status
Status and all communication will be sent to your My.PalmBeachState e-mail account including all acceptance documentation.
You will need a valid student ID and e-mail account to access this information.
Applicants who are selected will be notified approximately four weeks after the deadline date by Palm Beach State College email. Applicants will receive, via Palm Beach State College email, registration information, orientation dates, etc.
The provisional acceptance notice will include:
(1) Criminal Background form – includes Social Security number verification
(2) Controlled Substances and Alcohol screening forms
(3) Medical exam form
(4) Registration information
(5) Date of mandatory orientation
After admission, the above documentation must be on file in the Dental Health Services Coordinator’s Office.
Students are required to obtain a criminal background check and controlled substance and alcohol screenings (at their own expense) prior to the start of class. Failure to provide such documentation will result in termination of application.
3

Once all general admission criteria have been satisfied, a point system is utilized for selection of students to the program. In the event of a tie, a lottery selection system will be used.
COLLEGE DEGREE
(Associate degree or higher from a regionally accredited institution)………………………………………….......
FLORIDA RESIDENT
(Determined by student’s residency classification with Admissions)……………………………………………...
PALM BEACH COUNTY RESIDENT
(Determined by student’s residency classification with Admissions)……………………………………………...
1
1
1
3 TOTAL …………………………………………………………………………………………………………
4

DEADLINE: JULY 1, 2012 DENTAL ASSISTING APPLICATON
FALL 2012
1.
PALM BEACH STATE COLLEGE STUDENT ID ___ ___ ___  ___ ___  ___ ___ ___ ___
PROGRAM OBJECTIVE- 5155
2. HOME CAMPUS DESIGNATION  Belle Glade  Boca Raton  Lake Worth  PB Gardens
3. E-MAIL ADDRESS __________________________________________ @palmbeachstate.edu
4. NAME ____________________________________________________________________________________________________________
LAST FIRST MIDDLE SUFFIX
5. If any of your transcripts, test scores, etc., might arrive under any names other than those listed above, enter names here:
__________________________________________________________________________________________________________________
6. LOCAL ADDRESS _________________________________________________________________ ________________________________
NUMBER AND STREET ADDRESS CITY
_______________________________________________________________ ___________________ ______________
COUNTY (or PROVINCE) STATE ZIP CODE
7. HOME TELEPHONE ( )______________________ 8. DATE OF BIRTH ______________________
CELL PHONE ( )______________________
9. HIGH SCHOOL GRADUATE?
 Yes  No or GED ?  Yes  No
10. COLLEGE/UNIVERSITY
List all postsecondary colleges or universities you have enrolled. Omission of any constitutes falsification of records and voids application .
NAME OF INSTITUTION CITY/STATE DATES DEGREE CREDIT
To list more colleges/universities, attach a separate page .
11. Are you currently enrolled at Palm Beach State College?  Yes  No
12. Are you currently enrolled at another college/university?  Yes  No
13. FLORIDA RESIDENT?
 Yes  No
14.
Have PLACEMENT TEST SCORES ( Test of Adult Basic Education  TABE, Level A ) within two years prior to the start of the program?
 Yes  No
15. CUMULATIVE GRADE POINT AVERAGE ___________
I understand that falsification or omission of any information may result in my dismissal or rejection from the College.
I have read and understand all of the instructions pertaining to the Dental Assisting program as explained in the Dental
Assisting packet.
________________________________________________________________
SIGNATURE OF APPLICANT
___________________________________
DATE
5