PDF of Dental Assistant Application Booklet

Dental Assistant Application Booklet

All items on the requirement checklist should be submitted prior to 12:00 P.M. (noon) on May 14, 2021. Apply online at mntc.edu/apply by April 30, 2021.

Moore Norman Technology Center

Dental Assistant Application Booklet

2021-2022 Application Period: February 1, 2021 – May 14, 2021 12:00pm

All items on the requirement check list should be turned submitted prior to 12:00 P.M. (noon) on May 14, 2021.

Apply online at www.mntc.edu/apply by April 30, 2021.

1 Dear Prospective Student:

Thank you for your interest in Moore Norman Technology Center and the Dental Assistant program. Prospective dental assisting students have many educational choices. Therefore, I have enclosed a list of questions that should be asked of any dental assisting program in which you consider enrolling.

Health care professionals are in high demand today. Dental assisting can be a rewarding career choice or an opportunity for advancement. Students may choose to continue their education at a college or university and become a dental hygienist or dentist.

I hope you choose the MNTC Dental Assistant program. This application booklet is intended to provide general information about the program and guide you through the application and enrollment process. If you have any questions, please feel free to contact Student Services at [email protected].

Sincerely,

Bridgette Cannon, CDA, CDT Program Director

2 DENTAL ASSISTANT APPLICATION BOOKLET 2021-2022

Table of Contents INFORMATION SESSION...... 4 DENTAL ASSISTANT PROGRAM INFORMATION ...... 5-12 INFECTION CONTROL ...... 13-21 FEDERAL FINANCIAL AID ...... 23-24 MAKE AN INFORMED DECISION ...... 25-27 DENTAL ASSISTANT APPLICATION PROCESS ...... 28 Selection Points Checklist ...... 29 Immunization / Screening Requirements ...... 30 Immunization Sites ...... 31 OSBI Background Check Information ...... 32-33 WAIVER/RELEASE FROM ANY & ALL LIABILITY BY STUDENTS ...... 34 DENTAL ASSISTING PROGRAM COSTS ...... 35

3 Dental Assistant Information Session

Please review the online Dental Assisting Information Session Presentation before you begin to complete any requirements to apply for admission to the Dental Assisting Program.

Information sessions are an opportunity for applicants to learn more about the program, including requirements for acceptance and program completion.

How to access the online Dental Assisting Information Session Presentation: • Go to https://www.mntc.edu/long-term-programs/health/dental-assisting and download the presentation, located on the right side of the page.

DEADLINE FOR APPLICATION: Apply online at mntc.edu/apply by April 30, 2021. Submit all required documentation by 12:00 p.m. (noon) on May 14, 2021.

4 DENTAL ASSISTANT PROGRAM INFORMATION (1080 Hours) 2021-2022

The Moore Norman Technology Center Dental Assistant program provides training and skills necessary to become a Dental Assistant. A Dental Assistant is an integral member of a dental health team, responsible for a variety of patient care, office and laboratory duties. Dental Assistants make patients comfortable, prepare them for treatment, obtain dental records, prepare instruments and dental materials, and sterilize and disinfect instruments and equipment. Dental Assistants also assist the dentist with procedures, take and process dental x- rays, and instruct patients on postoperative and general oral health care. Assistants also take impressions, make casts from the impressions, and make temporary crowns. Dental Assistants with office duties schedule appointments, welcome patients, keep treatment records, and transact financial business.

The Commission on Dental Accreditation accredits dental schools, dental hygiene and dental assisting programs in the United States. The MNTC Dental Assisting Program became accredited in 2004 and has worked to maintain that accreditation. This recognition means that the MNTC Dental Assisting program meets or exceeds all of the national standards set for dental assisting education.

Moore Norman Technology Center’s Dental Assisting Program is accredited by the Commission on Dental Accreditation and has been granted the accreditation status of "approval without reporting requirements." The Commission is a specialized accrediting body recognized by the United Stated Department of Education. The Commission on Dental Accreditation can be contacted at 312-440-4653 or at 211 East Chicago Avenue, Chicago, IL 60611.

Who Can Apply?

The program is open to adult students only. Enrollment is limited. Students must meet all entrance requirements. The applicant is responsible for completing the application process and submitting all required documentation.

Schedule

Students attend class Monday through Friday from 9:15 a.m. to 4:10 p.m. Students will attend clinicals at the University of Oklahoma College of Dentistry from 8:00 a.m. to 4:30 p.m. during the first nine weeks of the second semester. During the last nine weeks of the semester, students will be assigned to dental offices, and the hours correspond to the hours of the clinical site. The program is completed in two consecutive semesters, August through May.

The 40 hours a week that students spend in clinical and class is not sufficient for successful completion of this program. Successful students spend a significant amount of preparatory time outside of class to be ready for the 40 hours of classroom and clinical work.

5 Entrance Requirements

• Apply online by April 30, 2021. • Meet with a Career Advisor. • High school diploma, its equivalent or Advanced Degree • Must meet or exceed minimum requirements o 12 hours of college credit General Education with GPA of 2.0 or o *ACT composite score range of 19+ or o SAT composite score range of 980+ or o Next Gen Accuplacer: Reading 250, Writing 243, Arithmetic 238 • DAT (abstract reasoning) ($17 fee) • Documentation of immunizations or titers • Proof of health insurance • OSBI Background check clear in 3 areas (criminal, sex offender, and violent offender) • Dental Assistant program information session • Students must provide own transportation to class and to clinicals

*Residual ACT scores are accepted

Training Includes • Head and neck anatomy • Dental materials • Tooth morphology • Dental software • Oral health and prevention of dental • Dental administration and communication disease skills • Infection control in dentistry • Dental ethics • Occupational health and safety • Dentistry and the law • Patient information and assessment • Dental instruments and procedures • Clinical Practice • Dental radiography

Expanded Duty Permits Oklahoma Board of Dentistry (OBD) approved training in Radiation Safety, Coronal Polishing/Topical Fluoride, Sealants, and Nitrous Oxide. Any student successfully passing all four Expanded Duty Courses along with completing our required curriculum will be granted the four expanded function endorsements by the OBD.

Dental Assisting National Board Exam (NATIONAL CERTIFICATIONS) Students will take the DANB exam in three components: Infection Control (ICE), Radiation Health and Safety (RHS), and General Chairside (GC). Any student successfully passing all three components of DANB, along with completing our required curriculum will graduate as a Dental Assistant (CDA).

6 Dental Assisting National Board (DANB) Program Performance Report

This table shows that the MNTC dental assisting students averaged scores compared to students taking the Dental Assisting National Board from other accredited dental assisting schools in Oklahoma, all other accredited dental assisting schools in the nation and then anyone who takes the DANB.

Year Exam MNTC Other All other All Other Student Accredited Accredited Candidates Average Scores Dental Dental Taking the Assisting Assisting Dental Schools in OK Schools in the Assisting Nation National Board Class of 2018/2019 Dental RHS 530 469 466 424 Assisting ICE 564 516 484 441 Class of GC 532 503 486 441 2018/2019

Radiation Health & Safety (RHS) Infection Control (ICE) General Chairside Assisting (GC)

2019/2020 RHS 540 – 508 – 465 – 421 ICE 558 – 528 – 489 – 433 GC 563 – 567 – 485 – 423

7 Dental Assisting Courses

Course Hours Pre-Clinical Dental Assisting 185 Essential Dental Assisting Skills 150 Chairside Fundamentals 205 Dental Assisting and Administration 145 Certification Courses for Oklahoma Expanded Duty Permits 45 Clinical Practice 350 Total Program Hours 1,080

Course Description

First Semester: 540 Hours

Pre-Clinical Dental Assisting – 185 Hours • Sciences in Dentistry: Sciences in Dentistry includes fundamentals of anatomy and physiology with an emphasis on the embryology, histology and anatomy of the head and neck. It will also include an overview of the dentition and detailed study of tooth morphology. • Infection Control in Dentistry: Infection Control in Dentistry prepares the student to implement policies and procedures necessary for protection and to prevent the transmission of disease in the dental office. In-depth study of the Bloodborne Pathogen Standard and CDC guidelines will equip students to base day-to-day infection control decisions on sound scientific information. • Dental Radiology: Dental Radiology will provide the theory and technique that a dental assistant needs to expose and process images, manage the patient, maintain proper infection control, and follow radiation safety procedures to produce diagnostic quality radiographs with minimal exposure to the patient. • Occupational Health and Safety: Occupational Health and Safety defines the roles and responsibilities of the various agencies and how they affect the dental office. Students will learn how to manage chemicals in the dental office and how to identify and correctly dispose of waste materials. The course will also cover musculoskeletal and cumulative trauma disorders commonly associated with dental assisting.

Essential Dental Assisting Skills – 205 Hours • Oral Health and Prevention of Dental Disease: Oral Health and Prevention of Dental Disease discusses the causative factors and disease processes of dental caries and periodontal disease. Emphasis is given to measures that are effective in improving oral health and preventing oral disease, including the role of

8 nutrition in general health. In addition, abnormal conditions of the oral cavity will be covered. • Patient Information and Assessment: Patient Information and Assessment will provide information and skills required when gathering patient information, obtaining patient vital signs, assisting the dentist in the assessment stages of dental care, and managing medically and physically compromised patients. In addition, the course will cover principles of pharmacology and preparedness to assist in a medical emergency. Upon acceptance into the program students will also become CPR Healthcare Provider certified. • Foundation of Clinical Dentistry: Foundation of Clinical Dentistry will provide information about the delivery of dental care, specific instruments and supplies that are used in dental procedures, and how to make a patient comfortable during patient care. • Dental Materials: Dental Materials will provide knowledge and skills basic to the preparation, manipulation, and application of dental materials. It will include restorative and esthetic dental materials, liners, bases, and bonding systems, dental cements, impression materials, laboratory materials and the fabrication of custom trays.

Chairside Fundamentals – 150 Hours • Assisting in Comprehensive Dental Care: Assisting in Comprehensive Dental Care will provide in-depth knowledge in clinical experiences. It covers materials and procedures of restorative dentistry as well as an overview of each dental specialty.

Second Semester: 540 Hours Dental Assisting and Administration – 145 Hours • Dental Assisting Profession: The Dental Assisting Profession provides an overview of the history of dentistry, and the roles, responsibilities, education and licensure requirements of each member of the dental health care team. It also covers dental ethics and the law. • Dental Administration and Communication Skills: Dental Administration and Communication Skills will provide an overview of communicating with colleagues and patients, learning the business systems used in the dental setting, managing the financial aspects of a practice, and marketing your personal skills. It is also designed to introduce students to the basic theories of psychology to have a better understanding of behavioral patterns and how those patterns relate to dentistry.

Certification Courses for Oklahoma Expanded Duty Permits – 45 Hours • Certification Courses for Oklahoma Expanded Duty Permits: Certification Course for Oklahoma Expanded Duty Permits are Oklahoma Board of Dentistry

9 approved courses in Radiation Safety, Coronal Polishing/Topical Fluoride, Sealants, and Assist in the Administration of Nitrous Oxide. Course content, evaluations, and certification requirements are based on Board of Dentistry Rules and Regulations, 195:15-1-3.

Clinical Practice – 350 Hours • Clinical Practice for the Dental Assistant: Clinical Practice for the Dental Assistant includes approximately 300 hours of clinical experience in which a student assists a dentist to perfect competence in dental assisting functions. Students earn approximately 150 hours of experience assisting dental students at the University of Oklahoma College of Dentistry. The additional hours are earned working in two internships.

In addition the MNTC Dental Assisting program has joined forces with Norman Regional Hospital, Norman Regional Hospital Foundation, Delta Dental, Norman Public Schools and the University of Oklahoma College of Dentistry to provide free dental work to Norman Public School children who are in need. This program is called “Little Smiles” and is still developing. At this time, the work is performed a half day each week from the last week of September through the middle of December and again from early January through the end of March. The dental assisting students assist senior dental students in performing dental procedures.

Program Specific Dress Code HAIR – long hair must be tied back. Medium to long hair must be secured in a manner that keeps it out of your face. Only head bands 2 inches or thinner are allowed. Hair color should be within human hair color range.

PROTECTIVE EYEWARE – must always be worn when participating in clinical activities that produce aerosols. (You will be given one pair and it will be your responsibility to take care of them.) They must be clean and readily available. (IF they are at home or in the cabinet, they will be of no use to you in the clinic.)

SCRUBS – daily wear scrubs are to be pink (no prints) and must be clean and neat ( no wrinkles). Pant legs are not to be touching the floor. Scrub tops must match the scrub pants. Tops may be worn under the scrub top as long as they are neat. Scrubs must be worn to school Monday through Friday. Program specific scrubs will be worn while attending the OU College of Dentistry and internships in private practice.

LAB JACKETS – will be laundered on site as needed and not to exceed a period of one week. Jackets are not to be worn off campus. They are to be hung in the lab after each use. On the designated laundry day you will be asked to turn the jacket wrong side out as you remove it and place it in the designated laundry basket.

10 MNTC PATCHES – students will be given 5 patches. One to be placed on each set of program specific scrubs and one on lab jacket. They are to be sewn on left sleeve, centered, and approximately one inch from the bottom of the sleeve.

SHOES – for daily clinic – athletic shoes, any color, must be CLEAN. For college of Dentistry & Internship – must be athletic type, leather, closed-toe, all WHITE and CLEAN. (Dirty shoes are not professional and therefore not acceptable.)

SOCKS – must be white, designed to totally cover the ankle, and worn daily. (No anklet socks.) This is an OU College of Dentistry requirement.

FINGERNAILS – must be short, natural and unadorned. NO EXCEPTIONS!!! Criteria for nail length: Look at your fingers from the palm side. If you see tips of fingernails they are too long and will need to be trimmed.

JEWELRY – one (1) small to moderate sized earring per ear. That means no bracelets, no gauging, no tongue jewelry and no jewelry in facial piercings. On or off, your jewelry is your responsibility.

TATTOOS – no visible tattoos. Tattoos must be covered at all times, classroom, clinic, OUCD and clinical sites. (It is your responsibility to keep them covered.)

Dental Assisting Graduation Requirements

ϒ Comply with Dental Assisting Dress Code ϒ Participate in HOSA ϒ Demonstration of Professional Qualities to participate in Clinical Internships ϒ Attendance Successful attendance means 10 or less absences per semester. Three tardies equal one half day absence. College of Dentistry and Private Practice has different attendance requirements. ∗ Pass each Course with 70% or higher • Pre-Clinical Dental Assisting • Chairside Fundamentals • Essential Dental Assisting Skills • Dental Assisting and Administration • Certification courses for Oklahoma Expanded Duty Permits • Clinical Practice ∗ Attend 5/9 ADAA/OCDAS monthly meetings ∗ Pass four Expanded Duty Function Courses with 70% or higher • Radiation Safety Completed by College of Dentistry (COD) Mid-January • Coronal Polishing and Topical Fluoride Completed by Little Smiles Mid-February

11 • Sealants Completed by Little Smiles • Assisting in the Administration of Nitrous Oxide Completed by Graduation ∗ Pass three DANB Exams • Radiation Health & Safety Completed by COD • Infection Control Completed by Graduation • General Chair Side Completed by Graduation ∗ Pass Career Tech Exam with 70% or higher ∗ Complete Minimum of 300 Clinical Hours

Dental Assistant Program Goals

1. Prepare dental assisting student for employment as a quality health care professional, meeting the changing needs of the students, employers and dental community.

2. Provide learning experiences which allow the students to develop an awareness of legal responsibilities, ethical behavior, and professional conduct, in accordance with the Oklahoma State Dental Act.

3. Prepare dental assisting students with academic knowledge and skill competence to successfully pass the Dental Assisting National Board and the Expanded Duty courses approved by the Oklahoma Board of Dentistry.

4. Provide opportunities for the development of communication skills which enable students to effectively communicate with employers, colleagues, and patients.

5. Provide experiences which allow the students to develop an awareness for the need of community service.

6. Provide classroom instruction and experiences which promote critical thinking skills.

7. Encourage students to assume responsibility for continued personal and professional growth by developing leadership skills, encouraging participation in professional organizations, and increasing their exposure to the industry.

12 INFECTION CONTROL

Rationale and Regulations

Rationale for Infection Control

Infection control is routinely practiced so that the procedures interfere with the steps in development of diseases that may be spread in the dental assisting clinic.

Goal of Infection Control

The goal of infection control is to reduce the number of microorganisms that may be shared between individuals or between individuals and contaminated objects and/or surfaces.

Pathways for Cross-Contamination

The infection control program is designed to prevent or at least reduce the spread of disease- producing agents. The five pathways for cross-contamination are:

• Patient to dental team • Dental team to patient • Patient to patient • Dental office to community, including families • Community to patient

RECOMMENDATIONS AND REGULATIONS

Resources:

Recommendations Centers for Disease Control and Prevention American Dental Association Organization for Safety and Asepsis Procedures

Regulations State and Local Food and Drug Administration Environmental Protection Agency Occupational Safety and Health Administration

13 Mechanisms of Disease Spread and Prevention PATHWAY SOURCE OF MODE OF DISEASE MECHANISM or SITE INFECTION CONTROL PROCEDURE MICROOGANISM SPREAD OF ENTRY into BODY Patient to dental Patient’s mouth Direct contact Through breaks in Gloves/handwashing team skin of dental team Immunizations Droplet infection Inhalation by dental Mask Rubber dam team Mouth rinsing Through breaks in skin of Gloves/handwashing Protective clothing Face dental team shield Rubber dam Mouth rinsing Through mucosal Mask Eyewear Face shield Rubber dam surfaces of dental team Mouth rinsing Immunization Indirect contact Cuts, punctures, or Needle safety and waste management Heavy needlesticks in dental gloves for cleanup team Ultrasonic cleaning – reduced need for hand scrubbing Instrument cassettes to reduce direct handling Antimicrobial holding solution Antimicrobial cleaning solution Through breaks in skin of Heavy gloves for cleanup Protective clothing dental team Immunization Patient’s skin lesions Direct contact Through breaks in Gloves/handwashing skin of dental team Immunization Dental team to patient Dental team’s hands Direct contact Through mucosal Gloves/handwashing (lesions or bleeding) surfaces of patient Care in handling sharp objects Immunizations Indirect contact Bleeding on items used in Gloves/handwashing Instrument sterilization patient’s mouth Surface disinfection Immunizations Dental team’s mouths Droplet infection Inhalation by patient Mask (oral or respiratory Face shield fluids) Through oral mucosal Mask surfaces of patient Face shield Patient to patient Patient’s mouth Indirect contact Through oral mucosal Instrument/handpiece sterilization Sterilization (instruments, surfaces, surfaces of patient monitoring hands) Surface covers Surface disinfection Handwashing and proper gloving Changing mask Decontaminating Changing protective clothing when needed Use of sterile or clean supplies Flushing dental unit water lines Monitoring water line anti-retraction valves Use of disposable items Office to community Patient’s mouth Indirect contact Cuts, punctures, breaks Waste management in skin, waste disposal Disinfection of impressions and appliances Proper management of contaminated laundry Handwashing Dental team to family Dental team bodily Direct/indirect contact Intimate contact Immunization fluids Community to patient Municipal water Direct contact Patient’s mouth Using separate water source Periodically disinfecting DUWL

14 EXPOSURE CONTROL PLAN

Universal/Standard Precautions Standard precautions expand the concept of Universal Precautions to design a standard of care that protects healthcare providers from pathogens that can be spread by blood or any other body fluid. All human blood and body fluids (including saliva) are treated as potentially infectious. Applying standard precautions requires that infection control procedures (e.g. handwashing, barriers, HBV vaccination, and waste disposal) are used for every patient.

CDC Standard Precautions • Wash hands before and after every patient • Wear gloves when touching blood, body fluids, secretions, and contaminated items • Use care when handling sharps • Wear a mask and eye protection, or a face shield during procedures likely to generate splashes or sprays • Carefully handle contaminated patient care items to prevent the transfer of microorganisms to people or equipment • Standard precautions must be used in the treatment of all patients

Category of Students Students are not protected by the standard because they are not employees.

All students will be routinely exposed to blood, saliva, or both during pre-clinical and clinical activities. (Category 1)

Training Students are trained in infection control and hazard communication, including OSHA Blood- borne Pathogens Standard and CDC Guidelines for Infection Control in Dental Healthcare Settings. Initial training is given prior to performing any task which may potentially expose a student to body fluids or hazardous chemicals.

Training requirements include: • epidemiology, modes of transmission, and prevention of HBV and HIV • location and proper use of all protective equipment • proper work practices using Universal Precautions • meaning of color codes, biohazard symbol, and precautions to follow in handling infectious waste • procedures to follow if needle stick or other injury occurs

Post-exposure Management Occupational exposure is defined as any reasonably anticipated skin, eye, or mucous membrane contact or percutaneous injury involving blood or any other potentially infectious materials.

1. Students must discontinue an activity immediately following an exposure. 15 2. Students perform basic first aid to flush or clean and dress the exposure site. 3. Attempts will be made to determine from patient information and investigation of records, if possible, the risk factor of the injury. 4. Students are encouraged to see their physician immediately for counseling to determine the course of follow-up. (Student is responsible for any cost incurred.) 5. Students will record the exposure incident on a prescribed form documenting: a. Name, address, and phone number of individual exposed b. Date, time, and location of exposure c. Description of exposure d. Personal protection worn at time of exposure e. Action taken post exposure

Immunizations Students are required to submit the following documentation prior to acceptance in the Dental Assisting program:

Hepatitis B • Documentation confirming dates of complete HBV series or • Documentation of a titer confirming immunity or • Signed declination form

Tuberculosis Skin Test • Current negative TB (PPD) skin test or negative chest x-ray.

MMR • Documentation confirming dates of complete MMR series or • Documentation of a titer confirming immunity

Students, faculty and appropriate support staff are encouraged to be immunized against and/or tested for infectious diseases, such as mumps, measles, rubella, hepatitis B, and tuberculosis prior to contact with patients and/or infectious objects or materials, in an effort to minimize the risk to patients and dental personnel.

Medical Marijuana Students are subject to drug testing at any time after program admittance, or at any time if a reasonable suspicion arises. Students may be denied admittance into the program, denied clinical experience, or be dismissed from the program for testing positive on a drug screening. It is important to understand that even if a student has a prescription for a controlled substance or other medication that impairs physical and/or cognitive ability, the student may be removed from the clinical setting or even the program, if the safety of others is at risk.

Per federal regulations, medical marijuana remains a drug listed in Schedule I of the Controlled Substances Act. Holding a medical marijuana license will not exempt students from a required negative drug screen to enroll in the program or participate in the clinical experience.

16 Pregnancy A declaration of pregnancy by a student is voluntary. The declaration must be in writing. Program completion is based on a student’s ability to participate in all pre-clinical and clinical skills and activities, including but not limited to, radiographic exposures and assisting in the administration of nitrous oxide.

A student that has a written statement declaring the state of pregnancy will be required to participate in all clinic activities that are not deemed to put the expectant mother or baby at risk.

The Program Director will discuss potential risks with the student and inform the student of their options for continuing their education.

Managing Contaminated Sharps Used needles are never recapped by using any technique that involves directing the point of the needle toward any part of the body. Students may recap a needle using the single-handed scoop technique or by using a safety device.

Sharps containers are located in treatment areas for immediate disposal of sharps.

Personal Protective Equipment Moore Norman will use the most current CDC Guideline for PPE. Moore Norman Technology Center will provide, at no cost to the student, appropriate personal protective equipment such as, but not limited to, gloves, gowns, masks, and protective eyewear. Appropriate PPE must be worn at all times during procedures that may involve exposure to blood, saliva, or other potentially infectious material.

Guidelines for the use of protective clothing • Protective clothing is not worn out of the clinic for any reason. • Protective clothing should be changed at least daily and more often if visibly soiled.

Guidelines for the use of masks • Masks should be changed for every patient or more often if heavy-spatter is generated during treatment, or if the mask becomes damp. • Masks should be handled by touching only the side edges to avoid contact with more heavily contaminated body of the mask. • Masks should conform to the shape of the face.

Guidelines for the use of gloves • All gloves used in patient care must be discarded after a single use. • Latex, vinyl, or other disposable medical quality gloves may be used for patient examinations and dental procedures. • Replace torn or damaged gloves immediately. • Do not wear jewelry under gloves. • Change gloves frequently during patient treatment. • Remove contaminated gloves before leaving the chairside during patient care, and replace 17 them with new gloves before returning to patient care. • Wash hands after glove removal and before regloving.

Guidelines for the use of overgloves • Overgloves are not acceptable alone as a hand barrier or for intraoral procedures. • Overgloves must be worn carefully to avoid contamination during handling with contaminated procedure gloves. • Overgloves are placed before the secondary procedure is performed and are removed before patient treatment is resumed. • Overgloves are discarded after a single use.

18 Hand Hygiene Hand hygiene For most routine dental procedures, hands should be washed with antimicrobial or non- antimicrobial soap and water. If hands are not visibly soiled, an alcohol-based hand rub may be used. For surgical procedures, a surgical scrub using antimicrobial soap and water should be used.

CDC Special Considerations For Hand Hygiene • Because rings and long fingernails can harbor pathogens, nails should be kept short and well manicured. • Rings, long fingernails and artificial nails are likely to puncture examination gloves and may poke a patient during an examination. • Microorganisms thrive around rough cuticles and can enter the body through any break in the skin. • CDC Guidelines recommend that rings, fingernail polish, and artificial nails should not be worn at work.

Engineering and Work Practice Controls

Eye wash station The eye wash station is used to flush eyes with water immediately following contact with chemicals, blood, or other potentially infectious materials.

Contaminated needles and other contaminated sharps Puncture resistant, leak-proof, color-coded sharps containers are placed in each treatment area. Contaminated sharps should be disposed in the containers immediately following use.

Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses Personal activities which include but are not limited to the above activities are prohibited in work areas.

Contaminated Laundry Contaminated protective clothing will be laundered on site. Standard Precautions are followed for handling and laundering the contaminated clothing.

Dental Unit Waterlines The dental units use a self-contained water reservoir system combined with a periodic application of chemical germicides. • Reservoirs are filled with distilled water immediately before use. • Water lines are flushed for several minutes at the beginning of each clinic. • Water is purged from the dental lines at the end of each clinic. • Empty reservoirs are placed on the units when not in use.

19 Cleaning, Disinfection, and Sterilization All contaminated surfaces must be pre-cleaned before they can be disinfected. Pre-cleaning contaminated surfaces before disinfection reduces the number of microbes and removes blood, saliva, and other body fluids.

The disinfection of all touch and transfer surfaces is accomplished using an EPA-registered hospital disinfectant and the spray-wipe-spray-wipe technique. Touch and transfer surfaces must be barrier protected or cleaned and disinfected between patients.

Surface barriers are used to prevent contamination on a surface so it will not have to be pre- cleaned and disinfected between patients. Barriers are never to be used on more than one patient.

All instruments, x-ray holders, metal impression trays, and handpieces must be heat sterilized. Sterilization is verified by monthly spore testing.

Single-use (disposable) items are used when appropriate. These items include but are not limited to saliva ejectors, air-water syringe tips, HVE tips, and surgical tips. Each item may be used once and disposed of in the appropriate waste container.

Contact Dermatitis and Latex Sensitivity Students are educated regarding the signs, symptoms, and diagnoses of skin reactions associated with frequent hand hygiene and glove use. A latex-safe environment is ensured for students, patients, and faculty.

Latex-sensitive students • Student would need medical verification of latex allergy. • Nonlatex gloves are available for student use. • Use of latex products would be kept to a minimum.

Care of patients with latex allergies • Allow no direct contact by the patient with latex. • Avoid handling instruments with latex gloves, including wearing latex gloves when packaging instruments for sterilization. • Use nonlatex substitutes for patient care. • There should be no latex in the treatment room.

20 Waste Management

CLASSIFICATION AND HANDLING REQUIREMENTS OF WASTE

MSDS Information: http://www.msds.com/

TYPE DESCRIPTION EXAMPLES HANDLING REQUIREMENTS

General waste Items that do not present Paper towels, disposable Discard in covered plastic or danger to mixing pads metal trash containers society Hazardous waste Presents a danger to Toxic chemicals Used amalgam humans or the • Commercial recycling environment container Lead • Commercial recycling container Fixer • Removed by campus maintenance and disposed in accordance with state regulations Contaminated waste Has been in contact with Used barriers, patient Discard in general waste blood or other napkins, gauze containers body fluids Infectious or regulated waste (biohazard) – waste that is capable of transmitting an infectious disease Dental offices are exposed to the three types of waste listed below. Blood and blood- soaked Blood or saliva can be Bloody gauze, disposable Discard in biohazard waste materials squeezed out or dried surgical tips container blood may flake off Pathologic waste Any tissue removed from Soft tissue, extracted Discard in biohazard waste a body or body part teeth container Sharps Any contaminated item Contaminated needles, Discard in sharps container that can cause a scalpel blades, located in the treatment area. parenteral injury orthodontic wires, reamers and files

21 Radiation Health and Safety

General Rules Faculty/Student ratio: 1/6 Students: • Must complete the Radiation Safety course approved by the Oklahoma Board of Dentistry (Rules and Regulations 195:15-1-4). • Must be appropriately supervised while exposing radiographs. • Must demonstrate proficiency exposing manikins prior to exposing patients. Infection Control • Film-holding or positioning devices are heat tolerant or disposable. • Gloves are worn when exposing radiographs and handling contaminated film packets. • Exposed film is transported and handled in an aseptic manner to prevent contamination of the developing equipment. • Digital sensors are covered with FDA cleared barriers. • Tubeheads and exposure buttons are barrier protected and/or disinfected with an EPA- registered intermediate-level disinfected. Patient Protection • Radiographs may only be exposed if they are prescribed by a dentist for diagnostic purposes. • The patient must have a signed patient consent form, a signed HIPAA consent form and a current, signed medical dental history. • A lead apron and a thyroid collar must be used on all patients for all intraoral exposures. Lead aprons w/out collars are used for panoramic radiographs. • Radiographic techniques must produce diagnostic quality radiographs with minimal radiation exposure to the patient and operator. Techniques include, but are not limited to the use of: o Fast film o Digital radiography o Film-holding devices o Proper exposure factors o Correct exposure techniques

Operator Protection • Never stand in the direct line of the primary beam. • Always stand behind a lead barrier or a proper thickness of drywall. • If a barrier is not available, stand at a right angle to the primary beam. • Never stand closer than 6′ from the x-ray unit unless behind a barrier. Radiation Monitoring • Students and staff wear dosimeter badges during all exposures. • Radiographic equipment is checked and monitored by the State Health Department.

22 FEDERAL FINANCIAL AID Federal Financial Aid is available to adult students attending a 600+ hour program at MNTC. The programs eligible to participate in Student Financial Aid (SFA) funds are approved and accredited by the Oklahoma Department of Career and Technology Education (ODCTE). For a complete list of approved programs, contact the Financial Aid office.

Federal Financial Aid Programs Offered at MNTC

The following are the financial aid programs available, if a student qualifies: • Oklahoma Tuition Aid Grant Program (a state funded program): This program is administrated by the Oklahoma State Regents for Higher Education. • Federal Pell Grant (Pell) Program: This is a need-based program, and eligibility is pre- determined by the Department of Education. • Federal Supplement Educational Opportunity Grant (FSEOG) Program: This program is offered to students based on need. To qualify for FSEOG, the Expected Family Contribution (EFC) must be zero. The funds will be awarded to the students who have completed their application and been accepted until funds are exhausted. Other Financial Assistance

Other Financial Assistance

Other federal/state funding agencies have assisted MNTC students in the past and will continue to assist for the current school year. To find out more about the agencies and available assistance, contact the Financial Aid Coordinator at 405-801-5046. • Vocational Rehabilitation Services • Bureau of Indian Affairs (BIA) • Workforce Investment Board

How to Apply for Financial Aid Programs (SFA) To apply for the Pell, FSEOG and OTAG, applicants must complete the Free Application for Federal Student Aid form called the FAFSA. NOTE: Students must apply for all other assistance or scholarship program(s) through the required agency or organization offering the funds.

The FAFSA may be submitted in the following ways: • By mailing the paper FAFSA to the Federal Processor (The FAFSA form is available by calling 1-800-4-FED-AID and requesting a paper application be mailed to you, or by printing a PDF version available at fafsa.gov). • Through the Internet by using FAFSA on the web at: fafsa.ed.gov

In order for MNTC to receive a student’s FAFSA information, our school code must be reported on the FAFSA. Our school code for the FAFSA is 012272.

23 Non-Discrimination Statement There will be no discrimination in the technology center because of race, color, sex, pregnancy, gender, gender expression or identity, national origin, religion, disability, veteran status, sexual orientation, age, or genetic information in its programs, services, activities and employment. The district also provides equal access to the Boy Scouts of America and other designated youth groups. The following people have been designated to handle inquiries regarding the technology center's non-discrimination policy: MNTC’s Executive Director of Human Resources (for employees) and Director Student Services/Marketing (for students). Inquiries concerning application of this policy may be made by calling 405-801-5000 or by visiting the Franklin Road Campus at 4701 12th Avenue NW, Norman, Oklahoma 73069.

International Applicants International Applicants must provide a high school equivalency assessment letter indicating foreign country education is equivalent to U.S. High School education, during the application period. The evaluation may be obtained through World Education Services at www.wes.org.

24 MAKE AN INFORMED DECISION (Questions to ask and responses to look for in a Dental Assistant program)

1. How long has the Dental Assistant program been in operation? What percentages of its graduates were able to find jobs in their field?

MNTC: MNTC’s Dental Assistant program was established in 1998. To date, all students who want to be employed as a dental assistant have been hired prior to or within a short period of time following graduation.

Other School:

2. How many students does the program accept each year?

MNTC: Enrollment is limited to 12 full-time students. Small classes allow for frequent one- on- one attention from the instructors and adequate clinical opportunities.

Other School:

3. How many full time instructors are available for the students?

MNTC: The program has one full time director/instructor and one part-time instructor. The director/instructor is a Certified Dental Assistant and Certified Dental Lab Technician with 37 years of dental experience. The part-time instructor is a CDA with 5 years of dental experience.

Other School:

4. What is the total program cost?

MNTC’s: For the most up-to-date estimate on program costs, please visit https://www.mntc.edu/long-term-programs/health/dental-assisting.

Other School: Other School:

25 5. Are there any other expenses? Books, scrubs, exams, etc?

MNTC’s: Everything needed to complete the program is listed on the expense sheet. Fees include tuition, liability insurance, ADAA student dues, textbooks, Oklahoma Dental Assisting permit, workbooks, exam fees, and picture ID badges required for the program. The expense sheet also lists approximate costs for required immunizations, scrubs, lab coat, shoes, drug testing, and College of Dentistry parking fees.

Other School:

6. Where are students assigned for clinical rotations?

MNTC: Students gain practical experience on clinical rotations at the University of Oklahoma College of Dentistry and private dental offices.

Other School:

7. Are the school and the program accredited by the agencies that make policies for Dental Assistant? Why is accreditation important to the student?

MNTC: The MNTC program is fully accredited by the Oklahoma Department of Career and Technical Education (ODCTE), the Oklahoma State Department of Education. The MNTC program is specifically accredited for Dental Assistant by the American Dental Association Commission on Dental Accreditation (CODA). The programs in dental education are accredited by the Commission on Dental Accreditation and have been granted the accreditation status of "approval without reporting requirements." The Commission is a specialized accrediting body recognized by the United Stated Department of Education. The Commission on Dental Accreditation can be contacted at 312-440-4653 or at 211 East Chicago Avenue, Chicago, IL 60611.

ADA accreditation is important to a student for several reasons. First, accreditation means that a program has been reviewed and has met national standards for dental assisting education. Secondly, students in an ADA accredited program in Oklahoma are eligible to participate in clinical rotations at the University of Oklahoma College of Dentistry. In addition, the Rules and Regulations of the State Board of Dentistry make provision for ADA accredited programs to submit curriculum for approval to teach courses required for permits to perform “expanded duty functions” as allowed by the state of Oklahoma. MNTC has been approved to teach Radiation Safety, Coronal Polishing/Topical Fluoride, Sealants, and Nitrous Oxide which makes students eligible to take the Dental Assisting National Board Exam.

26 Other School:

Other School:

8. How can I be absolutely sure that a program is accredited by the proper agency?

All: Ask to see the official letter from the Commission on Dental Accreditation or go to www.ada.org or www.danb.org and look up the school in question.

Other School:

9. How do I know if the program has adequate supplies and equipment for practice prior to being sent to a clinical setting?

All: Ask to see the lab facility. It should have multiple, completely equipped treatment areas. Equipment should include dental chairs, dental lights, intraoral and extra oral x-ray equipment, hand pieces, and a variety of dental instruments to provide hands on memorization and procedural use. The lab should also include a darkroom and an area for sterilization. The MNTC Dental Assistant clinic is large and, in addition to being fully equipped, has a storeroom with ample supplies of masks, gloves, disposables, etc.

Other School:

10. How can I tell which Educational Facilities are best for me?

Visit each of the programs that you are considering. Talk to the instructors, look at the facility, tour the lab, ask friends and family members what they know about the program and/or the school. It is important that you are well informed before you make any decision.

Other School:

These facts have been provided to help you make an informed decision about the program you are investigating. If you have questions or need clarification, please call 405-801-5000.

27 DENTAL ASSISTANT APPLICATION PROCESS Deadline Date: 12:00 P.M. (noon) on May 14, 2021

1. Complete a current MNTC application by April 30, 2021. • www.mntc.edu/apply.

2. Print an Application Booklet online at www.mntc.edu. • Carefully review the application booklet contents.

3. Meet with a Career Advisor. • Email [email protected] to schedule an appointment* with a Career Advisor. The Career Advisor will discuss application and selection process as well as review ACT/SAT/Next Gen Accuplacer scores provided. The Career Advisor will create a referral for assessment testing needed. *Please Note: Appointments will be conducted over the phone while campuses remain closed. They will notify you of any changes to location, communication, or building access when information becomes available.

4. Online Information Session Presentation (listed on page 4). • Go to https://www.mntc.edu/long-term/programs/health/dental-assisting and download the presentation, located on the right side of the page.

5. Complete Assessments. • Obtain assessment scores.

6. Required Transcripts. • Obtain and submit official high school transcripts or High School Equivalency certificates, and ALL college transcripts from any colleges you have attended.

7. Submit Documentation of Required Immunizations (listed on page 29).

8. Submit proof of health insurance.

9. Obtain an Oklahoma State Bureau of Investigation (OSBI) Background Check (information listed on pages 31-32). Must be obtained no earlier than February 2021.

10. If needed, complete and turn in all required financial aid documentation to the Financial Aid Office.

11. Submit all completed documentation by 12:00 pm (noon) on May 14, 2021. • Mail to* : Moore Norman Technology Center, Attn: Health Programs Dental Assisting PO Box 4701 Norman, OK 73070-4701 *must be postmarked prior to the deadline • Fax documents to: (405) 561-4186 • Emailed scanned documents to: [email protected]

All completed applications will be reviewed and students will be notified of selections by Mid June 2021. 28 Name: Date submitted: Complete this list and submit it with documentation of all the following transcripts, immunizations, waivers, and assessments for Dental Assistants. Student must complete: Items required for acceptance Points (if Date and results of Immunizations, Office Use Only Transcripts may be originals or copies. applicable, circle Titers, Waivers, Tests points that apply) Required Apply Online by April 30th, 2021

Required Meet with A Career Advisor High school diploma, its equivalent, or advanced Required by CODA (Standard 2-1) degree Required by clinical sites Proof of health insurance

Documentation of a complete Hepatitis B Vaccine (HBV) (complete series of 3) Hepatitis B (HBV) series or or positive titer positive titer is recommended by (submit copy of immunization record) industry standards. Required Signed Waiver of Liability Negative TB Skin Test or Chest X-ray Required (Must be dated March 1, 2020 or later) Rubella vaccination #1 (or titer) Rubella vaccination #2 MUST have all immunizations or Rubeola (Measles) vaccination #1 (or titer) titers for each Rubeola (Measles) vaccination #2 Mumps vaccination #1 (or titer) Mumps vaccination #2 OR OR MMR vaccination #1 Both of these MMR vaccination #2 Required Clear OSBI Background Check Must be obtained no earlier than Jan. 2020 (all 3 parts must be clear)

Information Session Presentation

College GPA Official College Transcript: minimum 12 hours general education courses (1000 level or above). The most recent GPA will be used. 2.0 – 2.99 3 3.0 – 3.99 6 4.0 or higher 9 Required: College GPA or ACT Composite Scores Required documentation: Test scores ACT/SAT Composite Score or Next Gen Accuplacer 19 – 20 6 Scores 21 or higher 9 SAT Composite Scores Required documentation: Test scores (Maximum awarded = 9 pts. Choose the option that 980 – 1050 6 maximizes available points.) 1060 or higher 9 Next Gen Accuplacer Scores Required documentation: Test scores Reading 0-249 0 250+ 3 Writing 0-242 0 243+ 3 Arithmetic 0-237 0 238+ 3

DAT (Abstract Reasoning) Percentile Ranking Required Percentile Ranking Score Score

TOTAL POINTS 29 Dental Assistant Program Immunization / Screening Requirements

The following documented immunizations, titers, and/or records must be submitted prior to acceptance in the Dental Assistant program. Documentation must be submitted to the Health Education Office, Franklin Road Campus.

Immunization records submitted must be copies. It is the responsibility of the applicant to make copies and retain originals.

Measles, Mumps, Rubella (MMR) You must have documentation of receiving 2 MMR vaccinations, or positive titers (blood tests that show immunity to Rubeola, Mumps, and Rubella). If any titer comes back as negative, you will need to have the vaccine administered.

Hepatitis B Vaccination

The hepatitis B vaccination is a series of three (3) injections given over a 6-month period. Applicants who have not completed the series and/or do not intend to do so must sign a declination form. Dental assistants are routinely exposed to blood and saliva and are at risk for contracting HBV. Think carefully about refusing the protective vaccination.

Applicants must submit one of the following to be considered for acceptance in the dental assistant program: • Documentation confirming dates of complete series or • Documentation of a titer confirming immunity or • Signed declination form

Tuberculosis Skin Test

Applicants must submit documentation of having a current NEGATIVE TB (PPD) skin test. For positive reactors, applicants must show proof of the positive reaction and a follow-up negative chest X-ray. The negative TB test or negative X-ray is required for participation in clinical activities at the University of Oklahoma College of Dentistry. Current is defined as a NEGATIVE TB (PPD) skin test taken after March 1, 2021.

Medical Marijuana

Students are subject to drug testing at any time after program admittance, or at any time if a reasonable suspicion arises. Students may be denied admittance into the program, denied clinical experience, or be dismissed from the program for testing positive on a drug screening. It is important to understand that even if a student has a prescription for a controlled substance or other medication that impairs physical and/or cognitive ability, the student may be removed from the clinical setting or even the program, if the safety of others is at risk.

30 Immunization Sites Location Services Offered/Costs

Norman Regional Hospital TB Testing $15 901 N. Porter, Norman, OK Hep B vaccines $40 each Health Promotion Department Varicella Titer $35 Gloria Moran, Nurse Hep B Titer $31 307-3172 Rubella Titer $25 Customers must be 18 years or age or older. Rubeola Titer $45 Cash only – no credit cards or checks. Insurance not filed. Mumps Titer $38 By appointment only. Directions to the office will be Tdap $60 given at the time appointment is made. Flu Vaccinations Seasonal Pricing

Cleveland Co. Health Department Call for availability of the following: MMR vaccines (series of 2), 250 12th Ave. NE 424 S. Eastern Ave. Varicella vaccines (series of 2), Hep B vaccines (series of 3), Norman, OK OR Moore, OK TDap, and Flu 321-4048 794-1591 Walk-In Clinics Based on Federal Grants, age restrictions, insurance, sliding Mon-Thurs 8:00am-4:00pm, Fri 8:00am-12:00pm scale fees, etc., charges may be applied.

Norman Regional Occupational Medicine TB Skin Test $20 not on Thursday 724 24th Avenue NW Suite 200 Hep B vaccines $50 each Norman, OK MMR Titer $114 360-6868 Varicella Titer $38 Appt. Preferred: Hep B Titers $32 M-F 8:00 am – 5:00 pm MMR vaccines (series of 2) $85 each ***Advise MNTC student to get this pricing. TDap vaccine $85—require 3 day notice

St. Anthony Hospital Physicians Outpatient Lab MMR Titers $110 1000 N. Lee, 3rd floor of Hospital Hep B Titers $10 Oklahoma City, OK Varicella Titers $30 272-6370 (main lab) or 844-989-6292 MMR, Varicella, Hepatitis $160 Open 24 hrs/day 7 days a week *Please add one $10 charge per patient for the draw fee.

Integris Southwest and Integris Baptist Medical Center TB Skin Test $15 not on Thursday 4200 S. Douglas Suite 214 3435 NW 56th Suite 909 Building A Hep B vaccines/Titer $40 each Oklahoma City, OK Oklahoma City, OK Hep B Titer $40 636-7336 951-2903 Rubella Titer $30 Mon, Tues, Wed, Fri Rubeola Titer $30 7:00 am – 4:00 pm Mumps Titer $30 No cash accepted – check, money order or credit card/debit card Varicella Titer $30

Affordable Quality Care TB Skin Test $20 620 24th Avenue SW ***Will do TB Skin Test for students under age of 18. Norman, OK 73069 (405)217-9997 Will do other vaccinations/titers ONLY with dr. referral. M-Thurs 8am-6pm Can set up low cost care with facility. $70 first visit, $60 Friday 8am-4:30pm thereafter.

Variety Care (405) 632-6688 18 and under free with SoonerCare. Norman Family Practice and Norman Women & Children’s Over 18 years old, Income based. 317 E. Himes St, 73069 1237 Alameda St. 73071 Monday-Friday 8:30am-5pm Monday-Friday 8am-5pm

All pricing verified 9/10/20 but subject to change per facility

31 OSBI Background Check Information As a part of the Moore Norman Technology Center’s Dental Assistant program, you will be required to practice your skills in facilities requiring background checks. Before you can be assigned to a clinic or other facility for your clinical or externship experience, you must have a background check that includes a sex offender check. If your criminal history is positive, the facility will then review your personal criminal history background. Each facility has the right to accept or reject any student based on information shown in the criminal history background check. Moore Norman Technology Center cannot overrule the decision of the clinical or externship sites. Criminal offender, sex offender and violent offender reports must be obtained no earlier than February 2021.

An application with a positive violent offender/sex offender result on the OSBI will not be considered for admission to the Dental Assisting Program.

If you are refused a clinical placement, you will be dropped from the program.

If you have lived in Oklahoma less than one year, you must submit the information from the state where you previously resided as well as the OSBI report. These reports must also include information regarding sex offender history.

It is your responsibility to obtain your record from the Oklahoma State Bureau of Investigation (OSBI) and provide it with your documentation. The OSBI has an online search system called Criminal History Information Request Portal (CHIRP) at https://chirp.osbi.ok.gov/. This system uses credit card or electronic transfer of funds to access all three required reports costing $20, which you can print instantly.

If you need to go in person, the OSBI office is located at 6600 North Harvey off NE 63rd, Oklahoma City, OK, one block west of Broadway Extension, Building 6 in the Broadway Executive Park. The telephone number is 405-879-2689, extension 0. The cost is $19.00; OSBI accepts cash or credit card. They will not accept checks. You will be required to bring your social security number, date of birth, full name and payment with you to be able to complete the process. A sample form is located on the next page. If you are a MNTC HIRE student, the DHS background check with this program will NOT meet the requirements for this program. See HIRE Coordinator with any questions.

If you have any questions regarding the application process, contact a career advisor at 405- 801-5000.

32 DATE OKLAHOMA STATE BUREAU OF INVESTIGATION Request Submitted via: Criminal History Record Information Request Type Of Search Requested:  Fax  Mail  In Person 6600 North Harvey Place ■ Name Based - $15.00 REQUESTS WILL BE RETURNED IN THE MANNER RECEIVED. Oklahoma City, OK 73116 ■ Sex Offender - $2.00 Mail requests should include postage-paid reply envelope. (405) 848-6724 ■ Mary Rippy Violent Offender - $2.00 (405) 879-2503 FAX Fax requests must include payment by credit card and a  State Fingerprint-based - $19.00 dedicated Fax Phone Line for return of completed search: https://osbi.ok.gov/ * Must provide fingerprint card. * Includes name based search.

ACCEPTABLE FORMS OF PAYMENT:  CASH  CASHIER’S CHECK / MONEY ORDER For Visa, MasterCard and Discover, security code is 3 digits on back of card.  BUSINESS CHECK No Personal Checks Accepted.  CREDIT CARD For Amex, security code is 4 digits on front. These are the only cards accepted. CREDIT CARD # EXPIRATION DATE SECURITY CODE

CARD HOLDER Please print the name of the individual card holder as it appears on the credit card.

CARD HOLDER SIGNATURE (REQUIRED)

REQUESTOR INFORMATION: (Type or print clearly in blue or black ink) Results will only be returned to the original requestor REQUESTOR’S NAME SIGNATURE OF REQUESTING PARTY STREET ADDRESS

CITY STATE ZIP PHONE NUMBER E-MAIL ADDRESS Requestors outside of the United States are strongly encouraged to provide an e-mail address for purposes of correspondence. PURPOSE OF REQUEST

SUBJECT INFORMATION: (Type or print clearly in blue or black ink) Forms with corrections made with white out or by striking through the fields in this section will not be processed. NAME LAST FIRST MIDDLE ALIAS/MAIDEN NAME(S) MAXIMUM OF THREE ALIAS NAMES PER REQUEST

DATE OF BIRTH (MM/DD/YYYY). If date of birth is unavailable, include exact age of subject.

RACE SEX SOCIAL SECURITY NUMBER SEARCH RESULTS (Please do not write in the spaces below): Oklahoma State Bureau of Investigation Oklahoma Department of Corrections Oklahoma Department of Corrections Computerized Criminal History Sex Offender Violent Offender Must have this Must have this Must have this section completed to section completed to section completed to meet requirement of meet requirement of meet requirement of application application application

Unless fingerprint cards are provided, record information is furnished solely on the basis of name or description similarity with the subject of your inquiry.

For questions on the Sex Offender / Violent Offender Registry, please contact the Oklahoma Department of Corrections. OSBI CHRU 02/2019 WAIVER/RELEASE FROM ANY & ALL LIABILITY BY STUDENTS AT MOORE NORMAN TECHNOLOGY CENTER IN HEALTH RELATED TRAINING

MUST COMPLETE Whether or not the student takes Hepatitis B Vaccinations (HBV) the undersigned student expressly waives any claim(s) and/or releases Moore Norman Technology Center and its employees and agents from any and all liability for exposure and/or infection of any sort, relating to and arising from participation in Moore Norman Technology Center Health Occupations Programs.

Signature Date

Witness Signature Date

MUST CHOOSE EITHER OPTION 1 OR OPTION 2 Option 1

I choose to receive the Hepatitis B (HBV) immunizations at my own expense. I understand the cost is approximately $0.00 - $210.00.

Signature Date

DATES OF IMMUNIZATIONS

1st (Must be verified with documentation) Signature (Applicant or Health Administration)

2nd (Must be verified with documentation) Signature (Applicant or Health Administration)

3rd (Must be verified with documentation) Signature (Applicant or Health Administration) OR Option 2

I choose not to take a vaccine.*

Signature Date

*Students will not be permitted in clinical areas until option 1 or 2 is chosen and this form signed.

34 PROGRAM COSTS

For the most up-to-date estimate on program costs, please visit https://www.mntc.edu/long- term-programs/health/dental-assisting