CCSF Dental Assisting Program

Dental Assisting Program Application

Cohort starts every Fall semester only. Accepting applications: 24 seats remaining
City College of San Francisco - Dental Assisting Program
50 Frida Kahlo Way, Cloud 304
San Francisco, CA 94112

If you have questions regarding the program, feel free to contact the program manager, Shirlene, at skwan@ccsf.edu

If you are not a CCSF credit student, please go to ccsf.edu/apply to become a student prior to submitting this application.

If you have not taken classes for more than 2 semesters, you must reapply to be a CCSF student in the Spring semester to get a registration date for the Fall semester.
Student Information
CCSF ID #*
Your CCSF student ID number typically starts with a W or @ or S. If you have an ID starting with a C, this is not your CCSF ID, please wait for an email from CCSF for your assigned student ID #.
Name*

First NameLast NamePreferred Name
Email*
example@example.com ; Please enter an email you check often. Letters of acceptances will be sent to this email.
Phone Number*
Please enter a valid phone number. Ex: (415) 123-4567

Which program length are you interested in?*

1 year2 year
How long have you been a resident of California?*
Are you a high school graduate?*

YesNo
If you are not a high school graduate, have you taken any of the following test?

General Development (G.E.D.)Certificate of California High School Proficiency Examination

Education
List your previous schools starting with the most recent. (include High School, CCSF, and any other colleges)

Please request official transcripts from previously attended schools and have them sent to the Dental Assisting Office.

Upload your unofficial transcripts if you have them available.
Upload your unofficial Transcripts:

Transcripts
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Name of School*
City, State*
First Attended*
Semester and Year (Spring 2024)
Last Attended*
Semester and Year (Fall 2024)
GPA*
Did you graduate from this school?*
Do you have other schools you would like to enter?*

YesNo
Name of School*
City, State*
First Attended*
Semester and Year (Spring 2024)
Last Attended*
Semester and Year (Fall 2024)
GPA*
Did you graduate from this school?*
If you have more than two schools to enter, please upload all remaining transcripts in the upload files area above.

Health Prerequisites
Each applicant is required to complete and provide proof the following prior to the Fall Semester. Please upload the following documents
- Negative TB (turbuculosis) test results within the last year (within 1 year of Fall semester start date). If you had a TB vaccine, please submit blood work for negative TB results. If you have TB, please submit xray and/or blood work showing TB is not active.
- Complete the first two Hepatistis B vaccines OR proof of Hep B immunity
- BLS for Healthcare Provider Certificate (BLS certificate is due the semester prior to internships).
  Please note: it is specifically the BLS for Healthcare provider certificate, not the typical CPR certificates for regular citizens.
  Students in the 2-year program can complete this in the semester prior to the internships.
  You must have an in-person skills check, cannot be online only.
  Must be American Heart Association (AHA) or American Red Cross (ARC) certified.
- Flu vaccination and COVID-19 vaccination is required by most of our internship offices. We highly recommend students to get the annual flu vaccine and booster shots for COVID-19. Although not required by CCSF, it can be a requirement for the internship offices to show proof.
If you do not have these files available at the time of application, please obtain them ASAP and upload them at a later time or email the program manager at skwan@ccsf.edu
Turbuculosis (TB) results

Cancelof
Hepatitis B Immunity or Vaccination Records

Cancelof
BLS for Healthcare Provider Certificate

Cancelof
Although the Flu vaccine and COVID-19 vaccine is not required at CCSF, offices for internships will be requiring proof of vaccination. Please have your proof of vaccination available.

Yes, I am fully vaccinated. I can submit proof of vaccination when requested.No, I am not vaccinated. I am planning to vaccinate prior to entering program and can submit the proof of vaccination prior to the start of internships in my final semester.

Work Experience
List the work you have done during high school, following graduation, or attending college. Include all volunteer work. This list will provide information on your interests and general activities before applying to the Dental Assisting Program.*
Why do you wish to become a registered dental assistant?*

Medical History
Person to contact in case of emergency: Name, Relation, Phone #*
Example: John Doe, Father, 415-123-4567
Family Dentist: Name, Phone #, Address
Example: Family Dental SF, 415-123-4567, 123 Cloud Dr, SF, CA 94112
Primary Care Physican: Name, Phone #, Address
Example: Dr. Floss, 415-123-4567, 123 Cloud Dr, SF, CA 94112
Are you currently under treatment?*

YesNo
If you are currently under treatment, for what?
Do you take any medicine such as insulin, thyroid, Dilantin, phenobarbital, digitalis, reducing pills, vitamins, allergens, liver, iron, penicillin, or other medications regularly?*

YesNo
If yes, what medications and what dose?
TO ALL APPLICANTS:
Given the limitations of routine health history information, it is not possible for dental practitioners to know the infectious disease status of patients. Since there may be some individuals you come into contact with during the program who may have an infectious disease, Universal Precautions are taught and used. For additional information, please read the Dental Assisting Program's Policies and Procedures on Bloodborne & Infectious Disease Policy

Since the CCSF Dental Assisting Program is approved by both credentialing available to California Dental Assisting Program - the American Dental Association and the California Board of Dental Examiners, we encourage all our graduates to sit for and successfully complete both the Dental Assisting National Board Examination and the Registered Dental Assistants Examination. All applicants for the Registered Dental Assistants Examination must complete a finger print card provided by the Committee on Dental Auxiliaries. This card is submitted to the California Department of Justice and will be checked for the applicant’s previous felony violations. Upon evaluation of past record(s) the applicant maybe refused their Registered Dental Assisting License by the Committee on Dental Examiners even though the applicant successfully completed both their written and practical examinations.
I have received and understand this application and health procedures and eligibility requirements packet.*

YesNo
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Dental Assisting Program Application

Student Information

Education

Prerequisites

Health Prerequisites

Work Experience

Medical History