Evaluation Worksheet for Certificate Dental Assisting (Extended-22-month)
SID: ________________________________ Certificate of Achievement - 3177
  Effective: Fall 2014
  Health Sciences
Name: ________________________________ (707) 527-4583

REQUIREMENTS: Complete 44.0 units

American Dental Association Requirements - complete 8.0 units
CourseDescriptionUnitsCompletedIn ProgressComments
PSYCH 1A General Psychology3.0   
Complete any combination totaling at least 2.0 units from the following:
ANAT 140 Fundamentals of Anatomy and Physiology2.0   
BIO 10 Introduction to Principles of Biology4.0   
Complete any combination totaling at least 3.0 units from the following:
FDNT 10 Elementary Nutrition3.0   
FDNT 62 Nutrition and Diet Therapy3.0   
Dental Assisting Requirements - complete 35.5 units
CourseDescriptionUnitsCompletedIn ProgressComments
DA 60 Applied Dental Science3.0   
DA 61 Introduction to Chairside Dental Assisting3.0   
DA 62 Introduction to Dental Procedures3.0   
DA 63 Dental Specialties3.0   
DA 64 Advanced Dental Assisting2.0   
DA 65 Dental Science3.0   
DA 66.1A Clinical Practice 13.0   
DA 66.1B Clinical Practice 25.5   
DA 67 Dental Office Management2.0   
DE 50 Introduction to the Dental Profession2.0   
DE 51 Occupational Health and Safety2.0   
DE 55A Introduction to Dental Radiology2.0   
DE 55B Dental Radiology2.0   
Dental Assisting (Extended-22-month) Requirements - complete 0.5 units
CourseDescriptionUnitsCompletedIn ProgressComments
DA 69 Chairside Skills Workshop0.5   

It is important that students who are completing an Associate Degree and desire to transfer to a four-year institution meet with a counselor to plan their lower division coursework. While many majors at SRJC are intended to align with lower division major preparation required by California public universities, specific lower-division major requirements vary among individual campuses. See a counselor, visit the Transfer Center, and check Guides For Transfer in Specific Majors, and ASSIST to review transfer preparation guides for specific schools and majors.


The program recommends that students take CS 5 (Computer Literacy) and HLC 160 (Medical Terminology) as a prerequisite to the program courses.

Students must provide documentation of a recent health examination, immunization records, and copy of a current CPR card, including adult, child and infant. (American Heart Association or Red Cross)
All courses in the program must be completed with a "C" or better.

Applicants who have completed all three courses required by the American Dental Association PSYCH 1A, ANAT 140 or BIO 10, FDNT 10 or FDNT 62) will be given preference for acceptance over applicants who have not completed all three courses. Applicants who have completed two of the courses will be given preference over those who have completed one of the courses. All prerequisites must be successfully completed before beginning the program.

    Evaluation worksheet completed upon receipt of Transfer Credit Evaluation form. Includes credit from other institutions only received to date.

    Evaluation worksheet completed for ________________________________. Includes all SRJC and transfer credit received to date.

Units completed:    __________
Units in progress:    __________
Total:    __________
    Requirements Completed
    Pending (work in progress)
    Requirements Not Completed



Date: ________________________   By: ____________________________________________