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)
Certified in Dental Infection Prevention and Control (CDIPC) Information Packet (PDF)
Dental Industry Specialist in Dental Infection Prevention and Control (DISIPC) Information Packet (PDF)
Radiation Health and Safety (RHS) exam Application Packet (PDF)

Consent Forms 
 Parent/Guardian Consent Form (PDF)

Work Experience Forms
CDIPC Work Experience Form Option 1 (PDF)
CDIPC Work Experience Form Option 2 (PDF)
CDIPC Work Experience Form Option 3 (PDF)
CDIPC Work Experience Form Option 4 (PDF)
DISIPC Work Experience Form Option 1 (PDF)
DISIPC Work Experience Form Option 2 (PDF)
DISIPC Work Experience Form Option 3 (PDF)

State Application Packets
 Arizona Coronal Polishing Certificate Application (PDF)
AMP/TMP/RF exams (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 (NYPDA) and RHS/ICE/NYPDA Exam Application (PDF)

Oregon Clinical Radiologic Proficiency certificate - Pathway I (PDF)
Oregon Clinical Radiologic Proficiency certificate - Pathway II (PDF)

Oregon Basic Dental Assisting (ORB) exam and Expanded Functions General Dental Assisting (ORXG) exam (PDF)
Oregon EFDA certificate - Pathway I (PDF)
Oregon EFDA certificate - Pathways II and III (PDF)
Oregon EFDA certificate - Pathway IV (PDF)
Oregon EFDA with Restorative Functions (PDF)

Oregon Basic Dental Assisting (ORB) exam and Expanded Functions Orthodontic Assisting (ORXO) exam (PDF)
Oregon EFODA certificate - Pathway I (PDF)
Oregon EFODA certificate - Pathways II and III (PDF)
Oregon EFODA certificate - Pathway IV (PDF)

 Oregon EFPDA certificate - Pathway I (PDF)
Oregon EFPDA certificate - Pathways II and III (PDF)
Oregon EFPDA certificate - Pathway IV (PDF)

Oregon Anesthesia Assistant certificate (PDF)
Oregon Anesthesia Assistant with IV Therapy certificate (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 and Renewal Forms
Certification Renewal Form (PDF)
Recertification Requirements (PDF)
NELDA Recertification Requirements (PDF)
CDIPC and DISIPC Recertification Requirements (PDF)
Emeritus Application (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)
Online Name Change Request

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.

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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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