ACADEMYOFDENTAL HYGIENE STUDIES
Pennsylvania Dental Hygienists’ Association
ContinuingEducationCourseApproval
Procedures Independent StudyGuidelines
On occasion, anindividual mayfindthat theyhaveparticipatedin acontinuingeducationprogram that does not havea PA Academy of Dental HygieneStudies CEUnumber. Inthis case, the individual mayapplyfor independent studycredit. Enclosedfor yourusearethe guidelines listed belowtoreceivecredit andappropriatemethodtofollow. Please feel free tocontact the Independent Study Chairif you haveanyquestions orrequire anyindividual assistance. Independent Study Chair is Deborah Gschrey, RDH, BS and phone number is 610.248.8961.
Guidelines:
- Fill out the Independent StudyApplication Form.
- Attach a copyofthebrochure, advertisement orJournal Article with the course description.
- Submit documentationof yourCertificateofAttendancefortheseminar orVerificationof CompletionfortheJournal Article.
- Keynoteaddresses, business meetings, announcements, lunches, andbreaks will not be countedinthenumberof hours awardedcredit.
- Tohave yourCEUs placedin PDHA’s computerrecords, your dental hygienelicensenumbermust belistedontheapplication.
- Sendcopies only, attachments will notbereturned.
- Ifotherdental hygienists areattendingthesamecourse, eachparticipant must submit theirown form andregistrationfee.
- The registration fee per person per course is:
- $3.00 for PDHA Distinguished Academy member.
- $5.00 for PDHA Academy member
- $8.00 for PDHA/ADHA member.
- $30.00 for non- ADHA/PDHA member
- PA Academy Independent Study course will be interpreted as appropriate interpretation requirements by the state board of dentistry. If any course is in question, please refer inquires to the state board of dentistry.
Makecheckpayableto PDHA and please mail check ONLY to:
Anita Jackson, 621 N. George St, York, PA 17404
Amount Paid for this course: ______
Pleasesendcompletedpacketto: Thank you for your continued support of our
AcademyCourseAccreditation Academy of Dental Hygiene Studies
PA Academy of D.H. Studies
Deborah Gschrey, RDH, BS
5085 Wagner Dr
Bethlemhem, PA 18020
ACADEMYOFDENTAL HYGIENE STUDIES
Pennsylvania Dental Hygienists’ Association
Independent StudyApplication
Name: ______
Address: ______
______
TelephoneNumber: ______E-Mail: ______
Dental HygieneLicenseNumber: ______
Provider: ______
Title: ______
Presenter: ______
Date: ______Location: ______
Typeof Presentation: (60Minutes =1CEU)
_____ LectureHours
_____ Clinical/LaboratoryHours
_____ Total ContactHours
Attachments:Thefollowinginformationmust beprovidedwiththis form (send copies only):
- Attach a copy of thebrochure,advertisementorJournal Article course description.
- Submit documentationof yourCertificateofAttendanceor Verificationof
CompletionfortheJournal Article.
The registration fee per person per course is:
- $3.00 for PDHA Distinguished Academy member.
- $5.00 for PDHA Academy member
- $8.00 for PDHA/ADHA member.
- $30.00 for non- ADHA/PDHA member
Make check payable to PDHA and please mail check ONLY to:
Anita Jackson, 621 N. George St, York, PA 17404
Please send completed packet to: Thank you for your continued support of our
Academy Course Accreditation Academy of Dental Hygiene Studies
PA Academy of D.H. Studies
Deborah Gschrey, RDH, BS
5085 Wagner Dr
Bethlemhem, PA 18020