Dental Hygiene Examination Forms

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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.

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2010 Application Forms

Certification of Graduation Form

Verification of Eligibility Form

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2010 Miscellaneous Examination Forms

Certification of Examination Preparation Form

Certification of Completion of Orientation Form

Interpreter Form

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2010 Examination Forms and Grade Sheets

Dental Hygiene Progress Form

Oral Observation Form

Treatment Selection Worksheet

Treatment Selection Evaluation Form

Treatment Evaluation Form

Treatment Selection Grading Room Request Form

Treatment Evaluation Grading Room Request Form

Instructions to Candidate Form

Patient Notification Form

Radiograph/Follow Up Care Form