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DOCUMENTATION OF JOB SHADOWING Applicant’s Name___________________________________________________________________ Name of Hygienist being observed______________________________________________________ Phone Number______________________________________________________________________ Office Address______________________________________________________________________ Dates Hours ________________ ______________________ ________________ ______________________ ________________ ______________________ ________________ ______________________ ________________ _______________________ ________________ _______________________ Please return by January 1st to: Western Kentucky University Department of Allied Health Program of Dental Hygiene 1906 College Heights Blvd. # 11032 Bowling Green, KY 42101
