Academics
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 Hall, 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.

Comments:____________________________________________________________________

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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.

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Print or Type Name                                                  Social Security Number

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Signature                                                                   Date