Dental Assistant Application Questionnaire (complete after submitting an Application for Admission)

All Dental Assistant applicants must read and agree to the conditions outlined in the Dental Assistant Handbook. This handbook can be found here. *

I have read, understand, and agree to the conditions outlined in the Dental Assisting Handbook.

I understand that I will need to provide my own Windows-based laptop for class. (Apple’s and Chromebooks are not compatible with program software)

I have read, understand, and agree to follow the dress code for the Dental Assisting Program.

I understand that I will need to provide my own lab shoes – which will be all leather shoes. Mesh or cloth shoes will not be allowed.

I understand that I am responsible for my own transportation to attend clinicals.

I understand that I am responsible for the cost of fuel to transport to and from clinicals.

I understand that I may have to drive approximately 1 hour away from campus to attend clinicals.

I understand that I will be required to attend a community service event. This event moves every year and it is not known where it will be this year, however, it will be in Kansas.

Please type your full legal name in the box below to sign this form. By signing, I certify that I have read and understand the Dental Assistant Handbook. When finished, please hit SUBMIT.

Email Address *

Contact Number *

(Please type your full legal name to sign) *