Application for Licensure as a Dental Hygienist by a Dental Student

The Board may grant a dental hygiene license to a student who has completed four full semesters in a CODA-accredited dental school provided that the applicant is of good moral character, has met the eligibility requirements and has submitted the following information to the Board: (1) An accurate, complete and signed application, as specified by the Board for that purpose; Office of Administration and Finance, unless waived in accordance with M.G.L. c. 112, § 1B; (3) An original transcript with the college seal from the program's authorized official stating the applicant's enrollment and successful completion of four semesters in a CODA-accredited dental school; (4) Documentation of passing each of the following examinations: (a) Part I of the ADA National Board Examination for Dentistry; and (b) The CDCA for Dental Hygiene or other state or regional examination approved by the Board; and (c) Massachusetts Dental Ethics and Jurisprudence Examination or a Board-approved successor examination; (5) Documentation of current BLS certification or CPR/AED certification; (6) A physician's statement made after an examination conducted within one year of the date of application, attesting to the health of the applicant and reporting impairments that may affect the applicant's ability to practice dental hygiene; (7) A passport-size color photograph; (8) A statement disclosing any and all disciplinary, civil or criminal action taken or filed against the applicant at any time after reaching the age of majority and prior to the date of application, with supporting documentation as the Board may require; (9) Proof satisfactory to the Board of good moral character; and (10) An attestation, signed under pains and penalties of perjury, that the applicant has complied with all state tax laws pursuant to M.G.L. c. 62C, § 49A and child support laws pursuant to M.G.L. c. 119A, § 16(a).