UCDH Program Application - January 2024 Start

UCDH is now accepting applications and conducting interviews for the Dental Hygiene Class beginning in January 2024. This application includes a $50 non-refundable fee required at the time of submission. Once this form has been completed, applicants will receive email instructions outlining the next steps of the process.

Keep in mind, this application must be completed in one session, and cannot be saved to return to.

This application and materials submitted is only applicable to the January 2024 start date. The college will continue to accept applications even after the class is filled. We urge you to submit your application as soon as possible.

For access to our College Catalog, please visit: https://www.ucdh.edu/college_catalog
For other questions, or to schedule a tour, please contact the Admissions office: 801-426-8234 OR admissions@ucdh.edu

NOTE: No documents will be stored/logged in our database without submission of this Application Form. Completion of the Utah College of Dental Hygiene Program Application and submitting the information/ required forms properly is the sole responsibility of the applicant.

Personal Information

NOTE: By providing your email and phone number above, you give UCDH representatives permission to contact you via email, phone call, or text.
Example MM-DD-YYYY

Which US State are you a legal resident of?

If you do not have a Social Security Number, please contact the UCDH Admissions Department before submitting your application.
UCDH is currently not accepting applications from foreign nationals, i.e. DACA, F-1, F-2, J1, J2, G series visa's, and other categories not included under U.S. citizenship.

Physical Address

Permanent Mailing Address

In the event you change addresses during the application stage or while in the program, list an address you can reliably receive mail to, regardless of your living address. (This may be the same as your Physical Address if no other addresses available).

Check all that apply

Emergency Contacts

Provide the names and contact information for two individuals, preferably including a parent, who always know how to contact you. Please notify UCDH of any subsequent changes in any of your contact information. If you want to authorize UCDH to discuss your application with someone other than yourself, please contact the admissions office for a release of information form.

Application Essay

Academic Details

Please attach an unofficial photo or scan of your ACT/SAT Score. This may also be listed on your High School Transcript or can be accessed through the ACT/SAT websites. Note: we do not have a school code with the ACT/SAT. If you access your score through those websites, request it for "personal use", then screenshot the score and upload it below. We do not require official copies.

Please list all Colleges/Universities attended. If possible include date ranges for each institution.

List prior degrees (do not include certificates or training courses)
Include the College/University and type of degree.

Applicant Prerequisite Audit

APPLICANT PREREQUISITE AUDIT: To aid admissions representatives in knowing what to look for regarding your academic history, students must fill out the Prerequisite Audit Section. This will outline when and where you took each of your prerequisite courses, along with the grade and credit hours awarded. This will be useful in identifying and verifying this information on your Official Transcripts.

NOTE: Prerequisites do not need to be completed at the time of application. However, all prerequisites must be completed by the time the program begins.

When completing the Prerequisite Audit Section below, please follow the format as shown in the example below for ALL the prerequisites. If you have not taken a prerequisite, please list the semester it is expected to be completed, along with the same information that is requested below. 

SAMPLE FORMAT: B+ 3.0 CHEM 1010 Introduction to Chemistry - Brigham Young University 
(Grade or semester to be completed, credit hours, course number, course title, college/university)


PREREQUISITE RETAKES: Applicants are responsible for reviewing the UCDH prerequisite retake policy on our website (https://bit.ly/3FNyM9w) prior to applying. Applicants that are ineligible due to this policy and still submit an application, will not be issued a refund of their application fee.

TRANSFERABILITY: If your course is not listed in our course equivalencies and you believe the course to be transferrable, download and print the Petition for Course Transfer Review. Any potential transfer course must meet UCDH criteria and course content must match the majorify of the required foundational knowledge. Petitions are only valid for the current application cycle. If an applicant submits a petition for one application cycle and then applies to a different application cycle at another date, a new petition would need to be submitted. Any past petitions would be void. If you are uncertain whether a petition form is needed for any courses you have taken, or if you have any questions, please contact the admissions department via email. To submit petitions, email the completed form, course description, and syllabus to admissions@ucdh.edu.

Petition for Course Transfer Form: https://bit.ly/3Lc41w2

Transcript Submission

TRANSCRIPT SUBMISSION: In order to evaluate eligibility for admission, students must submit Official Transcripts. To be considered official, the transcript must be a sealed, hard copy and mailed directly from the institution to UCDH. Official transcripts are required for high school and ALL college/university courses you have attended, even if prerequisites were not taken there.
Please contact all institutions you have taken secondary education courses from and have "Official" versions hard copy mailed to the following address:

Utah College of Dental Hygiene
Admissions/Records Office
1176 South 1480 West
Orem, UT 84058

Upon receipt of your transcripts, UCDH representatives will record relevant data and assess the fulfillment of the prerequisites.
I understand my application will not be considered complete, and will not be reviewed until Official Hard Copy Mailed Transcripts have been sent to UCDH.

Dental Experience

Please mark if you have completed the following programs:

Shadowing Form Download: https://bit.ly/3CI4Rz8

Please attach the completed and signed UCDH 2023 Observation Shadowing Hours Log. If your hours are not completed at the time of this application, please list below when your 40 shadowing hours are planned to be completed.

Please list the date your 40 shadowing hours are planned to be completed.

Lead Source


RE-APPLICANTS: If a re-applicant has previously been offered a conditional acceptance by UCDH in the past, and declined or withdrew, they will only be considered for alternate positions in the class they apply for. This also applies to any applicants that have started the program and willfully withdrew early.

BLOODBORNE PATHOGENTS STATEMENT: Students in the Dental Hygiene program may be exposed to bloodborne pathogens and other infectious and/or life threatening diseases while providing clinical services at UCDH. Students are provided with instruction on mechanisms of disease transmission and other potential risks associated with infectious diseases, including infection control procedures that can be used to potentially reduce the risk of disease transmission. The instruction on infectious diseases includes those published by national public health agencies, the Occupational Safety and Health Administration (OSHA) and the U.S. Centers for Disease Control and Prevention (CDC).

After acceptance into the BSDH program, students will be provided with a list of required immunizations, which must be completed prior to beginning the program.

ETHICAL ATTESTATION: I hereby certify that, to the best of my knowledge, the information in this application is true and complete without intent of evasion, false documentation, or misrepresentation.
I understand that if any information, at any time, is submitted to the UCDH Records Office under false pretenses or is not entirely accurate, truthful, is falsified in any way, or misrepresents in any fashion, that this will be sufficient cause and grounds to have my application rejected or revoked. This may also include a revoking of any awarded status by the admissions office and may also include immediate dismissal from the program.

Mandatory Fees
Application Fee 50
Total 50.00

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