Prerequisites: 1,000 hours of dental assisting experience or has graduated from a dental assisting program accredited by CODA, or is a currently certified dental assistant as designated by the DANB

must be BLS/CPR certified

A blank affidavit can be found here. Affidavits and CPR cards can be uploaded on the next page.

Hygienists do not need to upload an affidavit.

Personal Information

Do not use a generic office email address. Each person must register under their own unique email to maintain proper records.

Mailing Address
* 

Select the title of the person attending the course. 

This question is required.