COURSE PACKAGE FORM
Contact Person (s)
Tracy Gift
Date of proposal to Curriculum Sub-committee:
May 13, 2010
Purpose:
___ New
If this is a change, what is being changed?
(Check ALL that apply)
___
___
___
___
___
Effective Semester/Year
Fall 2010______
X Change
Update Prefix
Title
Learning Units
Competencies
Format Change
Spring 20_____
__ Delete
__ Course Description
__ Course Number
X Textbook
__ Credits
__ Prerequisite
Summer 20_____
COURSE INFORMATION
Prefix & Number: DAE 120
Title: Dental Specialties
Catalog Course Description:
Specialty and expanded skills for the clinical dental assistant including prosthetics,
orthodontics and surgical procedures are emphasized.
Credit Hours: 3
Lecture Hours: 2
Prerequisite(s)
DAE 108
Lab Hours: 2
Co-requisite(s)
DAE 120L
Does this course need a separately scheduled lab component? X Yes
Does this course require additional fees? If so, please explain. X Yes
Yes, the fee of $200 has been approved by the Governing Board.
____No
____No
Is there a similar course in the course bank? ___Yes (Please identify.) X No
Articulation: Is this course or an equivalent
offered at other two and four-year
universities in Arizona?
MCC Form EDU 0007 (rev. 10/21/09)
X No
___Yes (Identify the college, subject, prefix,
number and title:
Writing Across the Curriculum Rationale:
Mohave Community College firmly supports the idea that writing can be used to improve
education; students who write in their respective content areas will learn more and retain
what they learn better than those who don’t. Courses in the core curriculum have been
identified as “Writing Across the Curriculum” courses.
Minimum standards for the Writing Across the Curriculum component are:
1. The writing assignments should total 1500 – 2000 words.
For example, a single report which is 1500 words in length
OR
a series of essay questions and short papers (example: four 375-word
assignments) which total 1500 words could meet the requirement.
2. The writing component will represent at least 10% of a student’s final grade in
the course.
Is this course identified as a Writing Across the Curriculum course? ____Yes X No
(See addendum for writing rubrics)
Intended Course Outcomes/Goals
By the end of the semester, students will be able to:
1. Describe the process of a fixed and removable prosthetic restorations and the
fabrication of provisionals.
2. Identify and describe the various types of fixed and removable prosthetics.
3. Demonstrate proficiency in expanded functions.
4. Describe the process of oral and maxillofacial surgery, endodontics, periodontics,
orthodontics, pediatric dentistry and implantology.
Course Competencies and Objectives
By the end of the semester, students will be able to:
In a document designed by the American Dental Education Association, it is suggested that
allied dental students should exhibit competence in five domains. They are Core Competencies,
Health Promotion and Disease Prevention, Community, Patient/Client Care and Professional
Growth and Development.
Competency 1
Core Competencies (C) reflect the ethics, values, skills and knowledge integral to all aspects of
the allied health professions. These core competencies are foundational to all the roles of the
allied dental professional.
C.1 Apply a professional code of ethics in all endeavors.
MCC Form EDU 0007 (rev. 10/21/09)
C.2 Adhere to state and federal laws, recommendations and regulations in the provision of
oral health care.
C.3 Use critical thinking skills, comprehensive problem solving, and evidence-based
decisionmaking to identify oral health care strategies that promote patient or client
health and wellness.
C.4 Use evidence based decisionmaking to evaluate and incorporate emerging treatment
modalities.
C.5 Assume responsibility for professional actions and care based on accepted scientific
theories and research as well as the accepted standard of care.
C.6 Continuously perform self-assessment for life-long learning and professional growth.
C.7 Integrate accepted scientific theories and research into educational, preventative and
therapeutic oral health services.
C.8 Promote the values of the profession through service-based activities, positive
community affiliations, and active involvement in local organizations.
C.9 Apply quality assurance mechanisms to ensure continuous commitment to high standard
of care.
C.10 Communicate effectively with diverse individuals and groups, serving all persons without
discrimination by acknowledging and appreciating diversity.
C.11 Provide accurate, consistent and complete documentation for assessment diagnosis,
planning, implementation, and evaluation of oral health services.
C.12 Initiate a collaborative approach with all patients or clients when developing
individualized care plans that are specialized, comprehensive, culturally sensitive, and
acceptable to all parties involved in care planning.
C.13 Integrate emergent technologies and valid scientific research to achieve high-quality,
cost effective patient or client care.
C.14 Initiate consultations and collaborations with all relevant health care providers to
facilitate optimal treatments.
C.15 Manage medical emergencies by using professional judgment, providing life support and
utilizing required CPR and any specialized training or knowledge.
Competency 2
Health Promotion and Disease Prevention (HP) is a key component of health care. Changes
within the health care environment require the allied dental professional to have a general
knowledge of wellness, health determinants and characteristics of various patient or client
communities.
HP.1 Promote positive values of overall health and wellness to the public and organizations
within and outside the profession.
HP.2 Respect goals, values, beliefs and preferences of all patients or clients
HP.3 Refer patients or clients that may have physiologic, psychological or social problems for
comprehensive evaluation.
HP.4 Identify individual and population risk factors and develop strategies that promote health
related quality of life.
HP.5 Evaluate factors that can be used to promote patient or client adherence to disease
prevention or health maintenance strategies.
HP.6 Utilize methods that ensure the health and safety of the patient or client and the oral
health professional in the delivery of care.
Competency 3
Community (CM): Allied dental professionals must appreciate their roles as health professionals
at the local, state and national levels. While the scope of these roles will vary depending on the
MCC Form EDU 0007 (rev. 10/21/09)
discipline, the allied health dental professional must be prepared to influence others to facilitate
access to care and services.
CM.1. Assess the oral health needs and services of the community to determine action plans
and availability of resources to meet the health care needs.
CM.2 Provide screening, referral and educational services that allow patients or clients to
access the resources of the health care system.
CM.3 Provide community oral health services in a variety of settings
CM.4 Facilitate patient or client access to oral health services by influencing individuals or
organizations for the provision of oral health care.
CM.5 Evaluate reimbursement mechanisms and their impact on the patient or client’s access
to oral health care.
CM.6 Evaluate the outcomes of community based programs and plan for future activities.
CM.7 Advocate for effective oral health care for underserved populations.
Competency 4
Patient/Client Care (PC): The three primary allied dental professionals have different roles
regarding patient or client care. These are reflected in the competencies presented for each
discipline. The roles of the allied dental disciplines in patient or client care are ever changing,
yet central to the maintenance of health. Allied dental graduates must use their skills to assess,
diagnose (DH), plan, implement and evaluated treatment or services provided. Allied dental
personnel must be appropriately educated and credentialed for the patient and client services
they provide, and these requirements vary by individual jurisdictions,
PC.1 Systematically collect, analyze and record diagnostic data on the general, oral, and
psychosocial health status of a variety of patients and clients, using methods consistent with
medico-legal principals.
PC. 2 Recognize predisposing and etiologic risk factors that require intervention to prevent
disease.
PC.3 Recognize the relationship between systemic disease, medications, and oral health that
impact overall patient or client care and treatment outcomes.
PC.4 Identify patients or clients at risk for a medical emergency and manage the patient/client
care in a manner that prevents an emergency.
Planning
PC.5 Select and assemble the appropriate materials and armamentarium for general and
specialized patient or client care.
PC.6 Collaborate with the patient or client, and other health professionals and indicated, to
formulate a comprehensive care plan that is patient or client-centered and based on the nest
scientific evidence and professional judgment.
Implementation
PC.7 Utilize universal infections control guidelines for all clinical procedures.
PC.8 Collaboratively manage restorative procedures that preserve tooth structure, replace
missing or defective tooth structure, maintain function, are esthetic, and promote soft and hard
tissue health.
PC.9 Provide clinical supportive and intra-oral treatments within the parameters of general and
specialized patient care.
PC.10 Prevent, identify and manage medical and dental emergencies.
MCC Form EDU 0007 (rev. 10/21/09)
Evaluation
PC.11 Evaluate the effectiveness of the provided services and modify as needed.
PC.12 Compare actual outcomes to expected outcomes, reevaluating goals, diagnoses and
services when expected outcomes are not achieved.
Competency 5
Professional Growth and Development (PGD) reflect opportunities that may increase patients’ or
clients’ access to the oral health care system or may offer ways to influence the profession and
the changing health care environment. The allied dental professional must possess transferable
skills (e.g., in communication, problem solving, and critical thinking) to take advantage of these
opportunities.
PGD.1 Pursue career opportunities within health care, industry, education, and research.
PGD.2 Develop practice management and marketing strategies to be used in the delivery of
oral health care.
PGD.3 Access professional and social networks to pursue professional goals.
Teacher’s Guide
Course Textbook, Materials and Equipment
Textbook(s)
Software/
Equipment
Title
Author(s)
Publisher
ISBN
Title
Author(s)
Publisher
ISBN
Angel
Modern Dental Assisting
Torres and Ehrlich; Bird/Robinson
Elsevier
978-1-4160-4245-7
Modern Dental Assisting Student Workbook
Torres and Ehrlich; Bird/Robinson
Elsevier
978-1-4160-4990-6
Course Assessments
Description of Possible Course Assessments
(Essays, multiple choice, etc.)
Multiple choice, matching, essay exams, projects
Exams standardized for this course?
__ Midterm
__ Final
__ Other (Please specify):
Where can faculty members locate or access
the required standardized exams for this
course? (Contact Person and Location)
Example: NCK – Academic Chair Office
Are exams required by the department?
___Yes X No
If Yes, please specify:
MCC Form EDU 0007 (rev. 10/21/09)
Learning Units
Learning Unit Topic 1: Fixed Prosthodontics
Competency: C1, C2, C3, C4, C5, C6, C7, C9, C11, C13, C14, C15, HP1, HP4, HP5, HP6, CM2, PC1,
PC2, PC3, PC4, PC5, PC6, PC7, PC8, PC9, PC10, PC11, PC12
Objectives:
1. Describe the indications and contraindications for a fixed prosthesis.
2. Identify the steps for a diagnostic work up.
3. Identify the role of the laboratory technician.
4. Describe the differences among full crowns, inlays, onlays, and veneer crowns.
5. Identify the components of a fixed bridge.
6. Describe the uses of porcelain for fixed prosthodontics.
7. Describe the preparation and placement of a cast crown.
8. Discuss the uses of core buildups, pins and posts in crown retention.
9. Describe the use of retraction cord before taking a final impression.
10. Describe the function of provisional coverage for a crown or fixed bridge.
11. Demonstrate home care instructions for a permanent fixed prosthesis.
12. Demonstrate the placement and removal of gingival retraction cord.
13. Assist in the preparation procedure of an indirect restoration.
14. Assist in the cementation procedure of an indirect restoration.
Activities/ Assignments: Read Chapter 50, PowerPoint slides, electronic flashcards, workbook
pages, view DVD placing and removing retraction cord, Patient Case Study: Chester Higgins
Laboratory Activities: Placing and Removing Gingival Retraction Cord (Procedure 50-1), Assisting
in a Crown and Bridge Restoration (Procedure 50-2), Assisting in the Delivery and Cementation of a
Cast Restoration
Learning Unit Topic 2: Provisional Coverage
Competency: C1, C2, C3, C4, C5, C6, C7, C9, C11, C13, C14, C15, HP1, HP4, HP5, HP6, CM2, PC1,
PC2, PC3, PC4, PC5, PC6, PC7, PC8, PC9, PC10, PC11, PC12
Objectives:
1. Discuss the indication for provisional coverage of a crown or fixed-bridge preparation.
2. Describe the types of provisional coverage.
3. Discuss the dental assistant’s role in making a provisional crown or bridge.
4. Demonstrate home care instructions for provisional coverage.
5. Fabricate a custom acrylic provisional crown.
6. Fabricate a custom acrylic provisional bridge.
7. Fabricate a direct provisional crown from a preformed polymer crown.
8. Prepare and temporarily cement a polycarbonate crown.
Activities/ Assignments: Read Chapter 51, PowerPoint slides, electronic flashcards, workbook
pages, view DVD fabricating a custom acrylic provisional crown
Laboratory Activities: Fabricating and Cementing a Custom Acrylic Provisional Crown (Procedure
51-1), Fabricating and Cementing a Custom Acrylic Provisional Bridge (Procedure 51-2),
Fabricating and Cementing a Preformed Provisional Crown (Procedure 51-3)
Learning Unit Topic 3: Removable Prosthodontics
Competency: C1, C2, C3, C4, C5, C6, C7, C9, C11, C13, C14, C15, HP1, HP4, HP5, HP6, CM2, PC1,
PC2, PC3, PC4, PC5, PC6, PC7, PC8, PC9, PC10, PC11, PC12
Objectives:
1. Differentiate between a partial and a full denture.
2. Identify indications and contraindications for removable partial and full dentures.
3. List the components of a partial denture.
4. List the components of a full denture.
5. Describe the steps in the construction of a removable partial denture.
6. Describe the steps in the construction of a full denture.
7. Discuss the construction of an overdenture and an immediate denture.
MCC Form EDU 0007 (rev. 10/21/09)
8. Demonstrate home care instructions for removable partial and full dentures.
9. Describe the process of relining or repairing a partial or full denture.
10. Assist in the delivery of a partial denture.
11. Assist in the try-in of the wax setup for a full denture.
12. Assist in the delivery of a full denture.
Activities/ Assignments: Read Chapter 52, PowerPoint slides, electronic flashcards, Patient Case
Study: Jose Escobar
Laboratory Activities: Assisting in the Delivery of a Partial Denture (Procedure 52-1), Assisting in a
Wax Denture Try-In (Procedure 52-2), Assisting in the Delivery of a Full Denture (Procedure 52-3)
Learning Unit Topic 4: Dental Implants
Competency: C1, C2, C3, C4, C5, C6, C7, C9, C11, C13, C14, C15, HP1, HP4, HP5, HP6, CM2, PC1,
PC2, PC3, PC4, PC5, PC6, PC7, PC8, PC9, PC10, PC11, PC12
Objectives:
1. Discuss the indication for and contraindications to dental implants.
2. Describe the selection of patients to receive dental implants.
3. Identify the types of implants.
4. Describe the surgical procedures for implantation.
5. Demonstrate home care instructions and follow up visits required after dental implants are
received.
6. Assist in implant surgery.
Activities/ Assignments: Read Chapter 53, PowerPoint slides, electronic flashcards, workbook
pages, Patient Case Study: Gregory H. Brooks
Laboratory Activities: Assisting in a Endosteal Implant Surgery (Procedure 53-1)
Learning Unit Topic 5: Endodontics
Competency: C1, C2, C3, C4, C5, C6, C7, C9, C11, C13, C14, C15, HP1, HP4, HP5, HP6, CM2, PC1,
PC2, PC3, PC4, PC5, PC6, PC7, PC8, PC9, PC10, PC11, PC12
Objectives:
1. Describe the diagnostic testing performed for endodontic diagnosis.
2. List the conclusions of the subjective and objective tests used in endodontic diagnosis.
3. Describe diagnostic conclusions for endodontic therapy.
4. List the types of endodontic procedures.
5. Discuss the medicaments and dental materials used in endodontics.
6. Provide an overview of root canal therapy.
7. Describe surgical endodontics and how it affects treatment.
8. Assist in electric pulp vitality test.
9. Assist in root canal therapy.
Activities/ Assignments: Read Chapter 54, PowerPoint slides, electronic flashcards, workbook
pages, Patient Case Study: Antonio DeAngelis and Cindy Valladares
Laboratory Activities: Assisting in Electric Pulp Vitality Test (Procedure 54-1), Assisting in Root
Canal Therapy (Procedure 54-2),
Learning Unit Topic 6: Periodontics
Competency: C1, C2, C3, C4, C5, C6, C7, C9, C11, C13, C14, C15, HP1, HP4, HP5, HP6, CM2, PC1,
PC2, PC3, PC4, PC5, PC6, PC7, PC8, PC9, PC10, PC11, PC12
Objectives:
1. Describe the role of the dental assistant in periodontal practice.
2. Describe the procedures necessary for a comprehensive periodontal examination.
3. Identify and describe the instruments used in periodontal therapy.
4. Identify the indications for placement of periodontal surgical dressing and describe the
technique for proper placement.
5. Describe the role of radiographs in periodontal treatment.
6. Describe the indications and contraindications to use the ultrasonic scaler.
7. Describe the types of nonsurgical periodontal therapy.
8. Describe the goals of nonsurgical periodontal therapy.
MCC Form EDU 0007 (rev. 10/21/09)
9. List the types of periodontal plastic surgery.
10. Assist with a dental prophylaxis.
11. Demonstrate periodontal charting.
12. Assist with a gingivectomy and gingivoplasty.
13. Prepare and place noneugenol periodontal dressings.
14. Remove a periodontal surgical dressing.
Activities/ Assignments: Read Chapter 55, PowerPoint slides, electronic flashcards, workbook
pages, view DVD noneugenol periodontal dressing and removing a periodontal dressing, Patient
Case Study: Janet Folkner and Louisa Van Doren
Laboratory Activities: Assisting with a Dental Prophylaxis (Procedure 55-1), Assisting with
Gingevectomy and Gingivoplasty (Procedure 55-2), Preparing and Placing a Noneugenol
Periodontal Dressing (Procedure 55-3), Removing a Periodontal Dressing (Procedure 55-4)
Learning Unit Topic 7: Oral and Maxillofacial Surgery
Competency: C1, C2, C3, C4, C5, C6, C7, C9, C11, C13, C14, C15, HP1, HP4, HP5, HP6, CM2, PC1,
PC2, PC3, PC4, PC5, PC6, PC7, PC8, PC9, PC10, PC11, PC12
Objectives:
1. Describe the specialty of oral and maxillofacial surgery,
2. Discuss the role of an oral surgery assistant.
3. Discuss the importance of the chain of asepsis during a surgical procedure.
4. Identify specialized instruments used for basic surgical procedures.
5. Describe surgical procedures typically performed in a general practice.
6. Demonstrate postoperative care given to a patient after a surgical procedure.
7. Discuss possible complications resulting from surgery.
8. Prepare a sterile field.
9. Perform a surgical scrub.
10. Perform sterile gloving.
11. Assist in a simple extraction.
12. Assist in a multiple extraction procedure with alveoplasty.
13. Assist in removal of an impacted tooth.
14. Assist in suture placement.
15. Perform suture removal.
16. Assist in the treatment of alveolitis (dry socket).
Activities/ Assignments: Read Chapter 56, PowerPoint slides, electronic flashcards, workbook
pages, view DVD suture removal, Patient Case Study: Charles Fuller, Ingrid Pedersen, Harriet Ross
and Lee Wong
Laboratory Activities: Preparing a Sterile Field for Instruments and Supplies (Procedure 56-1),
Performing a Surgical Scrub (Procedure 56-2), Performing Sterile Gloving (Procedure 56-3),
Assisting in Forceps Extraction (Procedure 56-4), Assisting in Multiple Extractions and Alveoplasty
(Procedure 56-5), Assisting in Removal of an Impacted Tooth (Procedure 56-6), Assisting in Suture
Placement (Procedure 56-7), Performing Suture Removal (Procedure 56-8), Assisting in the
Treatment of Alveolitis (Procedure 56-9)
Learning Unit Topic 8: Pediatric Dentistry
Competency: C1, C2, C3, C4, C5, C6, C7, C9, C11, C13, C14, C15, HP1, HP4, HP5, HP6, CM2, PC1,
PC2, PC3, PC4, PC5, PC6, PC7, PC8, PC9, PC10, PC11, PC12
Objectives:
1. Describe the appearance and setting of a pediatric dental office.
2. List the stages of childhood from birth through adolescence.
3. Discuss specific behavior techniques that work as positive reinforcement when one is
treating children.
4. Describe why children and adults with special needs are treated in a pediatric practice.
5. Describe what is involved in the diagnosis and treatment planning of a pediatric patient.
6. Discuss the importance of preventative dentistry in pediatrics.
7. List the types of procedures that are performed for the pediatric patient compared with
MCC Form EDU 0007 (rev. 10/21/09)
those performed to treat patients with permanent teeth.
8. Assist in a pulpotomy of a primary tooth.
9. Assist in the placement of a stainless steel crown.
Activities/ Assignments: Read Chapter 57, PowerPoint slides, electronic flashcards, workbook
pages, Patient Case Study: Margaret Brown, Bret Goodman and Raul Ortega, Jr.
Laboratory Activities: Assisting in Pulpotomy of a Primary Tooth (Procedure 57-1), Assisting in
Placement of a Stainless Steel Crown (Procedure 57-2)
Learning Unit Topic 9: Coronal Polishing
Competency: C1, C2, C3, C4, C5, C6, C7, C9, C11, C13, C14, C15, HP1, HP4, HP5, HP6, CM2, PC1,
PC2, PC3, PC4, PC5, PC6, PC7, PC8, PC9, PC10, PC11, PC12
Objectives:
1. Explain the difference between a prophylaxis and coronal polish.
2. Explain the indications for and contraindications to a coronal polish.
3. Name and describe the types of extrinsic stains.
4. Name and describe the two categories of intrinsic stains.
5. Describe types of abrasives used for polishing the teeth.
6. Describe the types of abrasives used for porcelain esthetic restorations.
7. Name materials to be avoided when one is polishing esthetic restorations.
8. Describe the technique used for polishing esthetic restorations.
9. Demonstrate safety precautions to be followed during coronal polish.
10. Demonstrate coronal polish technique.
11. Demonstrate the handpiece grasp and positioning for the prophy angle.
12. Demonstrate the fulcrum or finger rest used in each quadrant during a coronal polish
procedure.
13. Demonstrate the proper seating positions for the operator and the assistant during a
coronal polish procedure.
14. Achieve a plaque biofilm and stain free oral cavity.
15. Complete a coronal polish without causing tissue trauma.
Activities/ Assignments: Read Chapter 58, PowerPoint slides, electronic flashcards, workbook
pages, view DVD coronal polish
Laboratory Activities: Rubber Cup Coronal Polishing (Procedure 58-1)
Learning Unit Topic 10: Dental Sealants
Competency: C1, C2, C3, C4, C5, C6, C7, C9, C11, C13, C14, C15, HP1, HP4, HP5, HP6, CM2, PC1,
PC2, PC3, PC4, PC5, PC6, PC7, PC8, PC9, PC10, PC11, PC12
Objectives:
1. Describe the purpose of dental sealants.
2. Describe two ways to achieve polymerization.
3. Describe how dental sealants prevent caries development.
4. Describe the clinical indications for dental sealants.
5. Describe the contraindications to dental sealants.
6. Describe the technique for placement of dental sealants.
7. Discuss the criteria for evaluating the placement of dental sealants.
8. Discuss the rationale for filled and unfilled sealant materials.
9. Explain the most important factor in sealant retention.
10. Demonstrate the steps in the application of dental sealants.
11. Describe and demonstrate the safety steps necessary for the patient and the operator
during sealant placement.
Activities/ Assignments: Read Chapter 59, PowerPoint slides, electronic flashcards, workbook
pages, view DVD applying dental sealants, Patient Case Study: Christopher Brooks
Laboratory Activities: Application of Dental Sealants (Procedure 59-1)
Learning Unit Topic 11: Orthodontics
Competency: C1, C2, C3, C4, C5, C6, C7, C9, C11, C13, C14, C15, HP1, HP4, HP5, HP6, CM2, PC1,
PC2, PC3, PC4, PC5, PC6, PC7, PC8, PC9, PC10, PC11, PC12
MCC Form EDU 0007 (rev. 10/21/09)
Objectives:
1. Describe the environment of an orthodontic office.
2. Describe the types of malocclusion.
3. Discuss corrective orthodontics, and describe what type of treatment is involved.
4. List the types of diagnostic records that are used to assess orthodontic problems.
5. Describe the components of the fixed appliance.
6. Describe the used and function of headgear.
7. Demonstrate good dietary and oral hygiene instructions given to an orthodontic patient.
8. Place and remove brass separators, steel separating springs and elastomeric rings
separators.
9. Assist in the fitting and cementation of orthodontic bands.
10. Assist in the direct bonding of orthodontic brackets.
11. Place an arch wire.
12. Place and remove ligature ties.
13. Place and remove elastomeric ties.
Activities/ Assignments: Read Chapter 60, PowerPoint slides, electronic flashcards, workbook
pages, Patient Case Study: Kevin McClelland
Laboratory Activities: Placing and Removing Brass Wire Separators (Procedure 60-1), Placing and
Removing Steel Separating Springs (Procedure 60-2), Placing and Removing Elastomeric Ring
Separators (Procedure 60-3), Assisting in the Fitting and Cementation of Orthodontic Bands
(Procedure 60-4), Assisting in the Direct Bonding of Orthodontic Brackets (Procedure 60-5), Placing
Arch Wires (Procedure 60-6), Placing and Removing Ligature Ties (Procedure 60-7), Placing and
Removing Elastomeric Ties (Procedure 60-8)
MCC Form EDU 0007 (rev. 10/21/09)