Dental Experience Verification Form
All applicants must have experience with intra-oral procedures by In-Office observation, Online Observation or dental assisting. All required hours must be with adult patients. If you’ve completed this form in it’s previous version, you may still submit this on your application. For any questions please contact dentalhygiene@utahtech.edu.
During the application process you will have the option to fill out this form digitally , or you can upload a physical copy.
Directions: You are required to select and provide verification for ONE of the options listed below.
- 500 Paid Dental Assisting Hours
- 50 Active IN-OFFICE Observation Hours,
- 25 ONLINE Observation Hours, with 2 Page Essay
- Partial IN-OFFICE and ONLINE Observation
Download Experience Verification Form