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If you have any questions during the application process, give us a call using the number up top

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We are excited that you are interested in joining our personalized dental assisting program. We will make sure whatever your goal may be, that we will help get you there.

First Name

Last Name

Phone Number

Email Address

Street Address

City

State

ZIP Code

Do you have a high school diploma or GED?

Yes No

Are you at least 18 years old?

Yes No

Do you have prior experience in dentistry or healthcare? If yes, please briefly describe your experience.

Are you able to meet attendance and punctuality expectations? (classes are on Saturday for about 3-3.5 hours)

Yes No

Do you have scheduling limitations we need to know about? If yes, please briefly describe below.

Are you able to meet our financial requirement? A 50% deposit (non-refundable) upon being accepted in the program and a 50% remaining balance due prior to the first class? Note, all payments are non-refundable.

Yes No

If there is anything else you need us to know, do so here.

Resume or any additional documentation you would like us to have

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Ready to Take the Next Step? Apply Online Below.

Ready to Take the Next Step?
Apply Online Below.