State-Required Assessment Forms
Revised 2008
English
Sample Notification Letter (PDF) | MS Word Version
Oral Health Assessment/Waiver Request Form (PDF) | MS Word Version
Arabic
Sample Notification Letter (PDF) | MS Word Version
Oral Health Assessment/Waiver Request Form (PDF) | MS Word Version
Armenian - Eastern
Oral Health Assessment/Waiver Request Form (PDF) | MS Word Version
Armenian - Western
Oral Health Assessment/Waiver Request Form (PDF) | MS Word Version
Chinese - Simplified
Oral Health Assessment/Waiver Request Form (PDF) | MS Word Version
Chinese - Traditional
Sample Notification Letter (PDF) | MS Word Version
Oral Health Assessment/Waiver Request Form (PDF) | MS Word Version
Hmong
Sample Notification Letter (PDF) | MS Word Version
Oral Health Assessment/Waiver Request Form (PDF) | MS Word Version
Korean
Sample Notification Letter (PDF) | MS Word Version
Oral Health Assessment/Waiver Request Form (PDF) | MS Word Version
Punjabi
Oral Health Assessment/Waiver Request Form (PDF) | MS Word Version
Russian
Sample Notification Letter (PDF) | MS Word Version
Oral Health Assessment/Waiver Request Form (PDF) | MS Word Version
Spanish
Sample Notification Letter (PDF) | MS Word Version
Oral Health Assessment/Waiver Request Form (PDF) | MS Word Version
Tagalong
Oral Health Assessment/Waiver Request Form (PDF) | MS Word Version
Vietnamese
Sample Notification Letter (PDF)
Oral Health Assessment/Waiver Request Form (PDF) | MS Word Version