Applications & Forms

Applications and forms are PDF files and require Adobe Reader. For best accessibility download the current Adobe Reader.

Applications

• Dentist *APPLY ONLINE*
  • Application Checklist for Dentist Licensure (PDF)
• Sedation Applications and Forms
  • Sedation Registration (PDF)
  • Moderate Level I (Enteral) (PDF)
  • Moderate Level II (Parenteral) (PDF)
  • Deep Sedation/General Anesthesia (PDF)
  • Itinerant Permit (PDF)
  • 14 Day Notification Form (PDF)
  • Certification Form (PDF)
• Limited Dental License (Retired) (PDF)
• Resident Dentist (PDF)
  • Residency Program and Supervision Form (PDF)
• Dental Hygienist *APPLY ONLINE*
  • Application Checklist for Dental Hygienist Licensure (PDF)
  • Application Checklist for Dental Hygienist Authorities (PDF)
• Dental Therapist / Provisional Dental Therapist
• Dental Therapy Application *APPLY ONLINE*
• Dental Therapy Practice Agreement Outline (PDF)
• Dental Therapy - Verification of Clinical Practice (PDF)
• Provisional Dental Therapy Application *APPLY ONLINE*
• Provisional Dental Therapy Practice Agreement Outline (PDF)
• Independent Practice Dental Hygienist *APPLY ONLINE*
  • Clinical Practice Verification (PDF)
• Public Health Dental Hygiene Authority
• Public Health Dental Hygiene Authority *APPLY ONLINE*
• Public Health Practice Agreement (PDF)
• Nitrous Oxide Analgesia Authority *APPLY ONLINE*
• Local Anesthesia Authority *APPLY ONLINE*
• Denturist (PDF) *APPLY ONLINE*
  • Application Checklist for Denturist Licensure (PDF)
• Denturist Trainee Registration (PDF)
  • Denturist Trainee Supervision Form (PDF)
• Dental Radiographer *APPLY ONLINE*
  • Application Checklist for Dental Radiographer Licensure (PDF)
• Expanded Function Dental Assistant (PDF)
  • Application Checklist for Expanded Function Dental Assistant Licensure (PDF)
• Faculty License
  • Dentist (PDF)
  • Dental Hygienist
  • Denturist
• Temporary License
  • Dentist (PDF)
  • Dental Hygienist (PDF)
    • Application Checklist for Temporary Licensure (PDF)

Board Approved Programs and Licensure Examinations

• Dentist
• Denturist (Examinations)
• Denturist (Programs)
• Dental Hygienist and Dental Hygiene Practice Authorities
• Dental Radiography
• Expanded Function Dental Assistant

Forms

• Certificate of Education Form (PDF)
• Certificate of Denturism Program Completion Form (PDF)
• Certificate of EFDA Training/Program Completion Form (PDF)
• Certificate of Program/Course Completion Form (PDF)
• Continuing Education Log (PDF)
• CE Provider Pre-Approval Form (PDF)
• Credit Card Authorization Form (PDF)
• Complaint Form (PDF)
• Complaint Form - Online
• Data Request Form (PDF)
• Social Security Number Affidavit

If you cannot find what you are looking for, send an email to the Board of Dental Practice.