Application for Enrollment - Atlanta Dental Assistant School

Application for Enrollment - GDCA

Applicant's Name*

First Last

Nickname

Applicant's Address*

Street Address City State ZIP Code

Applicant's Email*

Applicant's Mobile Phone*

Education - Diploma or GED Required

Highest Completed Level of Education*

High School Diploma
GED Equivalent
Associates Degree
Bachelor's Degree

Name of Most Recent School Attended*

Graduation Date or Last Attended School*

References

Reference #1 Name*

Reference #1 Phone*

Reference #1 Email*

Reference #2 Name*

Reference #2 Phone*

Reference #2 Email*

Reference #3 Name*

Reference #3 Phone*

Reference #3 Email*

Personal Statement

Personal Statement*

Please include a personal statement (250 words or less) describing your interest in dentistry and why you would like to become a dental assistant.

Student Portal Information

Your username will be the email address you used in connection to this application. Please set your desired password below:

Password*

Enter Password Confirm Password

Strength indicator

Agree to Terms and Conditions*

Agree

Click to View: Terms and Conditions

Application Fee*

Price: $50.00

You will pay in the next screen.

Total

$0.00

Intro to Dental Assisting

Chairside Assisting Skills

Dental Anatomy

Dental Radiography (x-rays)

Application for Enrollment - GDCA

Education - Diploma or GED Required

References

Personal Statement

Student Portal Information

New Courses

Contact Info

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