Course application

Entry Level Dental Assistant Program Application

Fill out the form carefully for course registration. Application fee of $150 is NON-refundable.
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have a high school diploma or GED? (If you have a foreign diploma, it must be translated. You can email us for more information about to do this.)*
Copy of Highschool Diploma or GED or Official Transcripts Verifying Graduation*

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Are you 18 or over?*
Copy of ID*

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Which class session you are interested in?*
Which location are you interested in attending for the on site clinic training?*
Phone Number*
Please enter a valid phone number.
E-mail*
example@example.com
Mobile Number*
Copy of health insurance card. This is not required, but you will have to sign a waiver stating you do not have health insurance on your official enrollment paperwork if you do not have health insurance.*

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Courses - Please select *
Why are you interested in this course? Tell us a little about your interest and your previous work or school experience. *
📚 Program Format
- The program is 12 weeks long.
- Lectures, exams, and homework are all online and self-paced.
- You’ll watch pre-recorded weekly videos anytime during the week before attending your clinic class.
- You will select a day session option OR evenings as your clinic class session. You will not attend Saturday's and evenings. Just one.
- Saturday clinic days are 9:00 AM – 3:30 PM, with a 30-minute lunch break, and are focused entirely on hands-on training with your instructor.
- Evening clinic 5:30 pm – 8:30 pm at our Orefield location and Lakewood location, and are focused entirely on hands-on training with your instructor.
- Evening clinic hours at our Lakewood location are Tuesday's and Thursday's 5:30 - 8:30 pm.
- Evening clinic days at our Havertown location are Thursday's 6:30 - 9:30 pm AND Friday's 5:30 - 8:30 pm, and are focused entirely on hands-on training with your instructor.
🗓 Reserving Your Spot

Once your application is received, it will be reviewed by our admissions team. If your application is accepted, you will be invited to complete the official enrollment paperwork.

Applications will be automatically denied if the applicant is under 18 years of age, does not have a high school diploma or GED, or is not financially able to attend the program.

If the program is full or your application is not accepted, your $150 registration fee will either be refunded.

💰 Tuition & Enrollment Fee

Tuition: $3,895
Registration fee: $150 (nonrefundable)

Please visit the "Financing Options" page on our website for more detailed information on payment plans and what is and is not included in your tuition.
How do you plan on paying for this course?*

I am working with CareerLink or ETPL and have been approved.I am paying in full before class starts to get the $500 discount.I am interested in the 3 months, no interest payment plan. I understand that I have to pay $1500 before the first day of class and then a payment plan will be sent to me for autopayments for the remaining balance.I am interested in the 6 months, 10%interest payment plan. I understand that I have to pay $1500 before the first day of class and then a payment plan will be sent to me for autopayments for the remaining balance.I am receiving money from another funding source not mentioned above that will be paying for my tuition. (I understand I will not be accepted into the program without proof of funding).

My Products*

Registration FeeThis is a nonrefundable deposit to secure your spot for the next upcoming class. Your application will not be accepted without the registration fee.

$150.00 Quantity

Total

$0.00

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Entry Level Dental Assistant Program Application

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