Blinn College
Dental Hygiene Program
Application Completion Form
Fall 2027
(Please complete and attach to the front of your application packet after you review, validate and sign)
Name
Blinn ID#
DOB (Month/Day ONLY)
Please place a check mark (✓) by all those items included in this packet, sign and date this form prior to mailing.
1.
Program Application (completed and signed)
2.
College Transcripts (enclosed)
Transcripts must be official and in sealed envelopes.
Name of Institution
a.
b.
c.
d.
3.
ATI TEAS – (scores enclosed)
4.
Recommendation Forms (enclosed)
Recommendation forms must be in sealed envelopes.
Name of Recommender
a.
b.
c.
5.
Community Service Log
6.
Employment /Military service verification
7.
Professional Certification
Student Signature
Date
This version is designed for reading and printing. Lines are intentionally non-fillable.