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
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
Print or Type Name
Social Security Number