Dental Hygiene Examination Forms
The following material contains those forms used by CITA in the administration of its licensure examinations. These forms are being provided to assist candidates who might wish to become familiar with their content and usage. These forms are also provided to candidates, on an as needed basis, during the various stages of CITA’s application and examination process. These forms are for information purposes only and the forms downloaded from this site are NOT for candidates to bring and use during the examination, with the exception of the Treatment Selection Worksheet and Radiograph/Follow Up Care Forms.
In order to view and/or download the forms, Adobe Acrobat Reader is required.
2012 Application Forms
Certification of Graduation Form
Verification of Eligibility Form
Dental Hygiene School Codes
Dental Hygiene Facility Fees
2012 Miscellaneous Examination Forms
Certification of Examination Preparation and Orientation Form
Interpreter Form
Incident/Disclaimer Form
Example of Dental Hygiene Examination Schedule
2012 Testing Site Facility Information
LSU School of Dentistry
UMC School of Dentistry
UNC School of Dentistry
Guilford Technical Community College (Coming Soon!!)
2012 Dental Hygiene Examination Forms and Grade Sheets
Dental Hygiene Examination Forms and Material Tutorial Packet
Progress Form
Oral Observation Form
Treatment Selection Worksheet
Treatment Selection Evaluation Form (Updated 11/23/11)
Treatment Evaluation Form
Treatment Selection Grading Room Request Form
Treatment Evaluation Grading Room Request Form (Updated 11/17/11)
Instructions to Candidate Form
Radiograph/Follow Up Care Form