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Registration
APPLICATION for Competitive Edge Dental Assisting Academy, LLC
"
*
" indicates required fields
CLASS
*
ASSISTING COURSE
CORONAL POLISHING (Jan 9 & 10, 2025)
SEALANTS (Dec 12, 2024)
(click all that apply):
Choose Assisting Course Start Date:
February 11, 2025
Select One
Coronal Polishing: Two day course with 14 CEs and must have current Tennessee RDA license ($295.00)
One day course with 6 CEs and must have current Tennessee RDA license ($245.00)
One day course with 5 CEs, must have a current Tennessee RDA license ($115.00)
Contact Info
Legal first and last name
*
First
Last
What name do you prefer to go by?
First
Email
*
Phone
*
DOB
*
MM slash DD slash YYYY
Address
*
Street Address
Unit
City
State / Province / Region
ZIP / Postal Code
Do you have a current US issued photo ID?
*
Driver’s License
Passport
Select One
Tennessee RDA#
*
Choose Your Course.
*
ASSISTING COURSE APPLICATION FEE (NON-Refundable) - $100
CORONAL POLISHING - $295
SEALANTS - $245
NITROUS - $115
Test - DO NOT USE
Payment Method
Check
Your Admissions Coordinator will be reaching out within the next few days with your acceptance or denial email. If accepted into our program, you will be invoiced via email a $100 non-refundable deposit in order to hold your spot. This deposit goes towards your remaining tuition balance.
Total
Phone
This field is for validation purposes and should be left unchanged.
Δ
APPLICATION for Competitive Edge Dental Assisting Academy, LLC
"
*
" indicates required fields
CLASS
*
ASSISTING COURSE
CORONAL POLISHING (Jan 9 & 10, 2025)
SEALANTS (Dec 12, 2024)
(click all that apply):
Choose Assisting Course Start Date:
February 11, 2025
Select One
Coronal Polishing: Two day course with 14 CEs and must have current Tennessee RDA license ($295.00)
One day course with 6 CEs and must have current Tennessee RDA license ($245.00)
One day course with 5 CEs, must have a current Tennessee RDA license ($115.00)
Contact Info
Legal first and last name
*
First
Last
What name do you prefer to go by?
First
Email
*
Phone
*
DOB
*
MM slash DD slash YYYY
Address
*
Street Address
Unit
City
State / Province / Region
ZIP / Postal Code
Do you have a current US issued photo ID?
*
Driver’s License
Passport
Select One
Tennessee RDA#
*
Choose Your Course.
*
ASSISTING COURSE APPLICATION FEE (NON-Refundable) - $100
CORONAL POLISHING - $295
SEALANTS - $245
NITROUS - $115
Test - DO NOT USE
Payment Method
Check
Your Admissions Coordinator will be reaching out within the next few days with your acceptance or denial email. If accepted into our program, you will be invoiced via email a $100 non-refundable deposit in order to hold your spot. This deposit goes towards your remaining tuition balance.
Total
Email
This field is for validation purposes and should be left unchanged.
Δ
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