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.

Candidate Handbooks
Candidate Handbook (PDF)
State Candidate Handbook (PDF)

National 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)

State Application Packets
Arizona Coronal Polish Certificate Application (PDF)
Arizona Expanded Functions — Restorative Exam and Certificate Application (PDF)
Maryland Expanded Functions Exams: General Dental Assisting and Orthodontic Assisting exams (PDF)
Missouri Test of Basic Dental Assisting Skills exam (PDF)
New Jersey Dental Radiologic Technologist Requirements (PDF)
New Jersey Expanded Duties — General Exam Pathway II (PDF)
New Mexico Advanced Certification Information (PDF)
New York Professional Dental Assisting exams (PDF)
Note: Effective November 5, 2019, the New York State Legislature changed laws affecting dental assistants. As a result, the New York State Board for Dentistry has discontinued the New York Infection Control (NYI) and New York Radiation Health and Safety (NYR) exams. Candidates may choose to instead apply for DANB’s Infection Control (ICE) and Radiation Health and Safety (RHS) exams. The New York State Board for Dentistry may be reached at 518-474-3817, ext. 300.

Oregon Clinical Radiologic Proficiency exam (PDF)
Oregon Clinical Radiologic Proficiency Certificate: Pathway II (PDF)
Oregon Expanded Functions — General Dental Assisting: EFDA Pathway I (PDF)
Oregon Expanded Functions — General Dental Assisting: EFDA Pathways II and III (PDF)
Oregon Expanded Functions — General Dental Assisting: EFDA Pathway IV (PDF)
Oregon Expanded Functions — Orthodontic Dental Assisting: EFODA Pathway I (PDF)
Oregon Expanded Functions — Orthodontic Dental Assisting: EFODA Pathways II and III (PDF)
Oregon Expanded Functions — Orthodontic Dental Assisting: EFODA Pathway IV (PDF)
Oregon Anesthesia Assistant Certificate (PDF)
Oregon Anesthesia Assistant with IV Therapy Certificate (PDF)
Oregon Expanded Functions — Dental Assistant with Restorative Functions (PDF)
Oregon Expanded Function Preventive Dental Assistant: EFPDA Pathway I (PDF)
Oregon Expanded Function Preventive Dental Assistant: EFPDA Pathways II and III (PDF)
Oregon Expanded Function Preventive Dental Assistant: EFPDA Pathway IV (PDF)
Washington State Restorative (WARE) exam (PDF)

Exam Outlines
DANB’s exam outlines list the topics covered on each exam.
Access DANB exam outlines

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 Materials Order Form (PDF)
Program Director Update 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
Sponsored Email Order Form (PDF)
State Publications Order Form  (PDF) 
Mailing List Rental Form (PDF)

DANB Policy Documents
DANB's Complaint and Investigation Procedures (PDF)
DANB's Disciplinary Policy and Procedures (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 (Level 1 Appeal) (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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