PAYMENTSTo assist students who are not financially capable of paying the total amount of tuition in full, the school will offer an easy interest free installment payment plan. These terms are available to all students who need assistance. The plan will consist of four (4) installments: 1 st Installment, Due Upon Enrollment, 2 nd Installment, Due 1 Week prior to Program start date, 3 rd Installment, Due the 4 th Week of the Program, 4 th Installment, Due the 8 th, Week of the Program.
LATE PAYMENTS: Installment payments not received 10-days after the due date shall incur a five percent (5%) penalty of the amount due.AGREEMENT DEFAULT: If student defaults upon this agreement, student will be responsible for the remaining balance owed after all discounts and adjustments have been revoked from account and all original course charges have been reinstated. In addition, student will be responsible for any collection fees or attorney fees incurred by Fullerton Dental Assistant School. Full remaining balance must be paid within ten business days of the day the student defaulted.
I have read and agreed to the refund & withdrawal agreement
I have read and agreed to the following understandings
I have read and agreed to the additional fees agreement
As an enrolled student with Fullerton Dental Assistant School, it is important that we consider the safety and medical wellbeing of all of our students. As a student, you are required to inform Fullerton Dental Assistant School Administration of ALL MEDICAL ISSUES.While this in no way disqualifies you from taking any of our courses offered, we need to make sure that we can make any special accommodations you may require. IE: periodic breaks beyond standard school schedule, a need for self-administered injections or oral medications during class time, etc.If you have a medical condition that may cause you to have an unexpected or unexplained episode such as, but not limited to: Asthma, Heart Condition, Diabetes, Epilepsy, and Fainting Spells which may require immediate care or ambulance services, IT IS THE SCHOOLS REQUIREMENT THAT THIS FORM BE ON FILE.If something unforeseen does take place, we will call for 911emergency services. However, please know that, we cannot and do not provide medical services.
Continuing Education Courses and Dental Assistant Program Agreement
I understand that in taking Continuing Education Courses and/or the Dental Assisting Program with Fullerton Dental Assistant School I must abide by all course prerequisites, requirements and patient criteria as listed below. I understand I must submit all prerequisites and certifications prior to the first day of class. I am aware that not meeting the course prerequisites, requirements or patient criteria will result in a failing grade.
Prerequisites Due At Time Of Registration For All Courses
Please read and approve
Must be able to communicate and understand English (reading and writing)● Must be at least 18 years old (Students who are below 18 years old can take the dental assisting program without CE courses)● Must have valid State Identification or U.S. Passport● Social Security Number or Individual Taxpayer Identification Number (ITIN)
Immunization Records
● Proof of Hepatitis B Vaccine (3 course vaccine, no more than 10yrs old)● Tuberculosis Test; (result must be negative and no more than 1 year old, positive resultsrequire chest x-ray with doctor’s report, results must be negative and not older than 5 years)
Certifications
CPR Card-BLS Healthcare Provider (required for Infection Control and Dental Practice Act, Radiation Health & Safety, Coronal Polish and Pit & Fissure Sealants)● Infection Control Certificate 8hr Class (required for Radiation Health and Safety, Coronal Polish and Pit & Fissure Sealants)● Coronal Polish Certificate (required for Pit & Fissure Sealants)
Requirements And patient Criteria For Radiation Health & Safety, Coronal Polish And Pit & Fissure Sealants
Radiation Health & Safety Course Requirements
The Radiation Health and Safety course requires students to attend the lecture, complete a written exam with a minimum passing score of 75% and successfully complete all required manikin x-rays before any x-rays are taken on a patient for the clinical exam. Each student is responsible for providing four (4) patients who meet the patient criteria for the clinical exam portion of the course (we recommend you have additional patients lined up as back up). *All four (4) patient clinical exams must be completed with a passing grade on the appointment date and time set up by the instructor. Clinical exam appointments will only be scheduled once lecture, exam, and manikin x-rays have been successfully completed.
Radiation Health & Safety Course Patient Criteria
● Patients must be 18 years or older● Patients must be in good health (A medical history form will be completed prior to treatment and approved by the instructor).● Patients must NOT be in the process of orthodontic treatment● Patients cannot be missing more than 1 tooth per quadrant (implants and bridges will count as missing teeth)● Patients cannot have dentures● Patient’s last FMX (18-20 films) must have been taken at least 1 year from the date of clinical exam appointment● Patient cannot be pregnant (patients who believe they might be pregnant are not candidates)
Coronal Polishing Course Requirements
Coronal Polishing Course requires students to attend the lecture, complete a written exam with a minimum passing score of 75% and successfully complete all required Coronal Polishing on manikin before the clinical exam on patients. Each student is responsible for providing three (3) patients who meet the patient criteria for the clinical exam portion of the course (we recommend you have additional patients lined up as back up).
Coronal Polishing Course Patient Criteria
● Patients must be 18 years or older● Patients must be in good health (A medical history form will be completed prior to treatment and approved by the instructor).● Patients must NOT be in the process of orthodontic treatment● Patients must be calculus free● No dental cleaning or deep cleaning in the last three months (light plaque is okay)● Patient cannot be pregnant (patients who believe they might be pregnant are not candidates)
Pit & Fissure Sealant Course Requirements
Pit and Fissure Sealant Course requires students to attend the lecture, complete a written exam with a minimum passing score of 75% and successfully complete all required Pit and Fissure Sealants on manikin before the clinical exam on patients.
Each student is responsible for providing four (4) patients who meet the patient criteria for the clinical exam (we recommend you have additional patients lined up as back up).
Pit & Fissure Sealant Course Patient Criteria
● Patients must be 18 years or older● Patients must be in good health (A medical history form will be completed prior to treatment and approved by the instructor).● Each patient must have 4 virgin teeth (caries free and unrestored),1 tooth per quadrant, must be premolars, molars (except 3rd’s)● Patients must NOT be in the process of orthodontic treatment● Patient cannot be pregnant (patients who believe they might be pregnant are notcandidates)
School Policies
Students are responsible for providing the required patients for all courses they will be taking with Fullerton Dental Assistant School .● Students are responsible for pre-screening their patients to ensure they meet the patient criteria prior to appointment date.● Once clinical exam appointments are assigned students will not be allowed to make any changes to their appointment date or time.● Students must confirm patient appointment date and time to ensure patients arrive on time to their appointments.● No one other than the scheduled patient will be permitted in the office and in the operatory at any time.● Students must arrive on time to all classes, on clinical days students must arrive 15 minutes prior to the class start time. The door will be locked once class starts and any late students will not be permitted to attend class. Students will not be permitted to use Fullerton Dental Assistant instructors or classmates/students as patients.● Any dishonesty or falsification of records will result in dismissal from the class/program and will be reported to the Dental Board of California.● Students are expected to conduct themselves in a respectful and professional manner with classmates, patients and all school staff, any misconduct is grounds for dismissal from the class/program.● Full payment for the course will be required if the student wishes to retake a course ● No exceptions will be made to school policies
I have read and agree to the Drug Free/Zero Tolerance School Policy
