Application For Dental Hygienist Licensure - Delaware Board Of Dentistry And Dental Hygiene Page 3
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9Arrange for the Board office to receive a letter of reference attesting to your good moral character and reputation.
Arrange for the Board office to receive license verification letters from each jurisdiction (state, U.S. territory or District
of Columbia) where you are now, or have ever been, licensed, sent directly from the jurisdiction to the Board office.
Submit tax form W-2s or other proof that you have practiced actively for three years in another state or U.S. territory.
Submit your completed, signed and notarized
Jurisprudence Examination for Dental Hygienist
Candidates.
Complete the Criminal History Record Check Authorization form to request State of Delaware and Federal Bureau of
Investigation criminal background checks. Follow the instructions on the authorization form to arrange to be
fingerprinted.
If you have never been issued a U.S. Social Security Number (SSN), submit a
Request for Exemption from Social
Security Number
Requirement.
The Privacy Act of 1974, Section 7, requires the following information to be given to all applicants: Applicants for any Delaware
professional or occupational license, permit, registration or certificate (other than Gaming permits) are required to provide a U.S.
SSN (29 Del. C. §8735(m)). The Division of Professional Regulation uses the SSN primarily to verify identity and safeguard
personal information. It may also be used to enforce child support obligation (13 Del. C. §2216) and for other lawful purposes.
Revised 9/2017
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