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
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