Forms Used on This Site

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All of the application packets, recertification forms, program director forms, reschedule an exam forms, request forms, order forms and DANB policy documents are available in one convenient location. Click on a form to download.

Application Packets
National Entry Level Dental Assistant (NELDA) Application Packet (PDF)
Certified Dental Assistant (CDA) Application Packet (PDF)
Certified Orthodontic Assistant (COA) Application Packet (PDF)
Certified Preventive Functions Dental Assistant (CPFDA) Application Packet (PDF)
Certified Restorative Functions Dental Assistant (CRFDA) Application Packet (PDF)
Radiation Health and Safety (RHS) exam Application Packet (PDF)
2017 Candidate Handbook (PDF)

Exam Blueprints
NELDA Exam Blueprint (PDF)
CDA Exam Blueprint (PDF)
COA Exam Blueprint (PDF)
CPFDA Exam Blueprint (PDF)
CRFDA Exam Blueprint (PDF)

Recertification Forms
NELDA Recertification Requirements (PDF)
Recertification Requirements (PDF)
Emeritus Application (PDF)
Professional Development Examination Program (PDEP) Form (PDF)
Request to Reschedule a PDEP Deadline or Retest Form (PDF)

Program Director Forms
Graduation Verification Instructions (PDF)
Group Testing Application (PDF)
DANB Application Packets Request Form (PDF)
DANB Materials Order Form (PDF)
Program Director Update Form (PDF)
Program Performance Report Form (PDF)
High School Program Reporting and Update Form (PDF)

Reschedule an Exam Forms
Request to Cancel a Testing Window (PDF)
Request to Receive a New Testing Window Due to an Emergency (PDF)
Request a New Testing Window (PDF)

Request Forms
Candidate/Certificant Request for Verification (PDF)
Employer Request for a Verification of a Candidate/Certificant (PDF)
Reasonable Accommodations Form (PDF)
Request a Duplicate Certificate (PDF)
Request for Duplicate Exam Results (PDF)
Request a Notarized Certificate (PDF)
Request for Hand Scoring of Exam Results (PDF)
Name Change Request (PDF)

Order Forms
State Publications Order Form  (PDF) 
Mailing List Rental Form (PDF)
Anniversary Recognition Gift Order Form (PDF)

DANB Policy Documents
DANB's Complaint and Investigation Procedures (PDF)
DANB's Disciplinary Policy and Procedures (PDF)
DANB's Policy and Procedure for Appeal of Clinical Exam Results (PDF)
DANB's Appeal Policy & Procedures (PDF)
DANB's Background Information Policy (PDF) 
Usage Guidelines for DANB Marks (PDF)
How to Use DANB Certification Marks: Guidelines for Certificants (PDF)
Request for Reconsideration (PDF)

Adobe Reader

You will need the current version of Adobe Acrobat Reader to download and read these forms. Older versions of this software (6 and older) may fail to display certain items, which may result in an incomplete application submission.

If you do not have the current version of Adobe Acrobat Reader, you can download it free from Adobe.

Please contact DANB’s Client Services if you have any questions concerning these forms or have any trouble downloading these files.

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