Dental Hygiene (A.A.S.)

Dental Hygiene Technical Standards Form

Please print this form, fill it out and return it to: Hudson Valley Community College, Dental Hygiene Program - Fitzgibbons Health Technologies Center, 80 Vandenburgh Avenue, Troy, NY 12180.

Are you able to satisfactorily perform all of the Technical Standards identified in this document with or without reasonable accommodation? Yes____   No ____
If you do have a disability or related special needs, and require accommodations to perforrn the Technical Standards please contact the Disabled Student Services Office.





I have read, understand, and believe that I will be able to meet the technical standards if I become a Dental Hygiene student at HudsonValley Conununity College.

__________________________                               ____________________
Print or Type Name                                                  Social Security Number

__________________________                               ____________
Signature                                                                   Date