Office Experience-recommendation

Office Experience

The Letter of Reference Form must be received by the Dental Hygiene Program by the appropriate deadline (Guaranteed Admission Application – March 15th, or Competitive Entry Application – February 1st). Should deadline date fall on a weekend all materials will be accepted till 5:00 pm the Monday following the deadline. Thank you for your timely assistance.

References must be completed by supervisor at location where office experience was completed. They may NOT be a family relation.

Applicants Name*

First Name

Last Name

Hours Applicant Observed/worked*


	YES	NO
The observer was on time.	: The observer was on time. (YES)	The observer was on time. (NO)
The observer was dressed appropriate and professionally.	The observer was dressed appropriate and professionally. (YES)	The observer was dressed appropriate and professionally. (NO)
The observer demonstrated a positive attitude	The observer demonstrated a positive attitude (YES)	The observer demonstrated a positive attitude (NO)
The observer asked appropriate questions.	The observer asked appropriate questions. (YES)	The observer asked appropriate questions. (NO)
The observer acted professionally at all times.	The observer acted professionally at all times. (YES)	The observer acted professionally at all times. (NO)
I would recommend this person to the CNCC dental hygiene program.	I would recommend this person to the CNCC dental hygiene program. (YES)	I would recommend this person to the CNCC dental hygiene program. (NO)