Application Addendum for the

Dental Assistant Program Jointly sponsored by the American Red Cross, Parris Island MCRD, and Beaufort MC Air Station Dental Clinic I understand that the Dental Assistant Program (DAP) is filled through a selective interview and evaluation process, and that application does not guarantee participation. _______ Please Initial

I understand that successful completion of the classroom portion of the program requires attendance, without absence, to the first week of classroom training and a minimum score of (75% or score) on the final exam. _______ Please Initial I understand that successful completion of the chairside/practical portion of the program requires completion of at least 600 hours during the six (6) months immediately following the classroom hours. I also understand that Instructors may assign additional practicum hours as needed to ensure that minimum skill level is met. _______ Please Initial I understand that to complete practical hours minimum during six months, applicants should expect to volunteer 24 hours per week, and that any volunteer who misses 3 or more consecutive weeks without a verifiable emergency will be automatically dropped from the program. _______ Please Initial I understand that the DAP is neither a licensure program nor does it provide Board Certification. _______ Please Initial I understand that the purpose of the DAP is to train volunteers who wish to serve at the Dental Clinic (requirement of 600 hrs for local dental clinics and it could be up to 1,000 volunteer hours at other installations) _______ Please Initial In addition, I understand that participants in the DAP are responsible for knowing and following the guidelines for American Red Cross volunteers including the Code of Conduct, Dress Code, and Confidentiality Agreement as well as the policies of the Dental Clinic. _______ Please Initial I understand that the DAP is a voluntary program designed to provide crucial clinical skills, and that any behavior that disrupts or distracts from the learning environment may lead to dismissal. _______ Please Initial I understand the childcare will not be provided for the DAP. _______ Please Initial I have read and understand the above statements regarding successful participation in the Dental Assistant Program. I recognize the commitment expected of volunteers and will do my best to act as a good steward of the resources used in the training and management of the DAP. ________________________________ Signature

____________ Date