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Dental Assisting ProgramMaleah Brooks RDA – Dental Assisting Program DirectorSTUDENT INFORMATION SHEET2015 - 2016 Career and Technical Education Program - ApplicationDental Assisting 1www.avropdentalassisting.weebly.comInformation: Mrs. Maleah Brooks, 948.8552 ext. 331, or e-mail avropdentalassisting@yahoo.comA. General InformationthEligibility: High School students (from Antelope Valley High School District) who will be in 11 orth12 grade by 15-16 School YearCredits: 10 per semester for Dental Assisting (Class is 2 periods per day)Classes Meet:Monday, Tuesday, Thursday, Friday 1:25 – 3:17Wednesday 12:20 – 2:02Prerequisite: Read the classroom guidelines www.avropdentalassisting.weebly.comSchool:For students not attending AV High School, applying for this class does not imply admissioninto AV High School; students will retain their enrollment at their original high school site, andbe present on the AVHS campus for the Dental Assisting Program ONLY.B. Student Requirements Must have own transportation to internships (for 2nd semester) and, if coming from anotherschool, must have transportation to AV High School Must arrange class schedule at high school to be able to attend this program - studentshouldn’t take more than 30 minutes from start of lunch to get to AVHS to attend class.C. Student ApplicationComplete the attached application - Print or Type the finished copyAttach to the application:(If you have a problem getting these items, contact Mrs.Brooks) Attendance Record for past 3 semesters or 2 years--request from the Attendance clerk atleast 2 weeks in advance of submitting Unofficial copy of your transcript-- request from the Registrar at your school-- do this at least2 weeks before submitting Two (2) completed Recommendation Forms (in sealed envelopes) – forms are in thisdocument. Have a teacher; counselor, employer or other adult complete a recommendationform. Give form to adult early allowing time for person to complete and return form to you toattach to your application. This information form signed by parent/ guardianSubmit the application and all attachments by April 10, 2015 to:Maleah Brooks, Dental Assisting Program, AVHS, 44900 Division Street, Lancaster, CA 93535.( application must be received or postmarked by April 10, 2015.)D. Selection ProcessThe selection committee will review: A pattern of good attendance for the present year based on the attendance report from yourschool
Completed application indicating an expressed and demonstrated interest in the dental field.An unofficial transcript indicating a pattern of successful completion of classes.Minimum GPA of 2.0Two or more completed recommendation forms, sealed in envelopes and attached to theapplication.Interviews will be the week of April 20th at AVHS.You will beEMAILED with your appointment time. You will be notified if you are selected, by email, before May 4th . Approximately 30-35students will be selected.Required: For students selected for ROP Dental Assisting 1: Student and parent/ guardianmust attend a Parent Information Night Meeting June 1, 5 – 7pm in room 331 at AVHS If you are not able to attend, please let Mrs. Brooks know in advance. If you do not attendthe meeting and didn’t give prior notice, a new student will be chosen for your spot in theclass.AFTER ACCEPTANCE TO THE PROGRAM: By the 1st day of class:Laboratory Fee includes HOSA membership & Club Tooth ShirtParent Advisory Committee membership is also required. (Will address at the Parent meetingon May 11th.)Bring a copy of the following:Provide proof of a current negative tuberculosis check – in the past yearMust obtain additional vaccinations besides those required for high school attendance* Copy of proof of Hep B Vaccination, Tetnus (within last 7 years)*(Normal waiver provisions DO NOT apply, these vaccination requirements are OSHAguidelines, not ROP)
Dental Assisting Program2015 – 2016 Regional Occupational ProgramSTUDENT APPLICATIONFORDental Assisting 1Student Name:(Please print)Home Address:Home Phone:Current School:Email Address(required)How did you hear about this program?City: Zip:Date of Birth:Student ID#:Please answer the following questions. If you need more room attach a separate sheet of paper.1. Why do you want to take this class? (Please go into detail)2. What have you done to demonstrate your interest in taking this class? (Examples: volunteer work,medical/health care related classes, advanced level science and math classes, AP and or honors levelclasses, personal and life experience)3. What are your educational plans for after you graduated from high school?4. Experience – List any work experience you have had that demonstrates your ability to take on responsibility.This includes paid, unpaid, volunteer, community service or informal jobs such as babysitting, mowinglawns, working in a family business, etc.
5. Activities - List any clubs, sports, organizations that you are/have been involved with both in and out ofschool.6. Interests - List three things that you like to do in your spare time. This could include sports, reading,writing, collecting or building something, etc.7. What means of transportation will you use to get to internship sites (and AV High School if you attendanother school)?Student AcceptanceI have read and understand all of the basic requirements for applying for the Dental Assisting Program.Signature of StudentDateParental PermissionAs a parent or guardian I have read the basic requirements and I agree to let my son/daughterattend this program if accepted.Signature of Parent/GuardianDate
Dental Assisting ProgramRecommendation FormDental Assisting 1Student Name:(Please print)Current School:Dear Teacher/Counselor/Employer:The above named student is applying for the Dental Assisting Program ROP Class at AV High School. Pleasecomplete the student ratings below and make comments in the space provided.Please return this form SEALED IN AN ENVELOPE to the requesting student, or to Maleah Brooks c/o AVHSDental Assisting Program. The deadline for submitting a completed application is April 10, 20151. Daily attendance is:excellent good fair poor(0-2 absences) (3-4 absences) (5-8 absences) (Frequent absence)*Any special circumstances for absences:2. Arrival for class is generally on time:always most of the time sometimes seldom3. Completion of class assignments, homework, special projects is generally completed and submitted ontime:always most of the time sometimes seldom4. Participation and demonstrated interest in activities is:high very good good fair5. Because the spaces for these classes are limited, it is important that those selected will have acommitment to complete the course. This means that the student must be at school everyday, on-time,and with completed assignments. Based on your information, would you recommend this student.highly recommended recommended with reservations would not recommend6. Additional comments:Reference Name (print)SignatureDate School/OrganizationPhone/Exte-mail:
Dental Assisting ProgramRecommendation FormDental Assisting 1Student Name:(Please print)Current School:Dear Teacher/Counselor/Employer:The above named student is applying for the Dental Assisting Program ROP Class at AV High School. Pleasecomplete the student ratings below and make comments in the space provided.Please return this form SEALED IN AN ENVELOPE to the requesting student, or to Maleah Brooks c/o AVHSDental Assisting Program. The deadline for submitting a completed application is April 10, 20151. Daily attendance is:excellent good fair poor(0-2 absences) (3-4 absences) (5-8 absences) (Frequent absence)*Any special circumstances for absences:2. Arrival for class is generally on time:always most of the time sometimes seldom3. Completion of class assignments, homework, special projects is generally completed and submitted ontime:always most of the time sometimes seldom4. Participation and demonstrated interest in activities is:high very good good fair5. Because the spaces for these classes are limited, it is important that those selected will have acommitment to complete the course. This means that the student must be at school everyday, on-time,and with completed assignments. Based on your information, would you recommend this student.highly recommended recommended with reservations would not recommend6. Additional comments:Reference Name (print)SignatureDate School/OrganizationPhone/Exte-mail:
The above named student is applying for the Dental Assisting Program ROP Class at AV High School. Please complete the student ratings below and make comments in the space provided. Please return this form SEALED IN AN ENVELOPE to the requesting student, or to Maleah Brooks c/o AVHS Dental Assisting Program.
