Application For Dental Hygienist Licensure - Delaware Board Of Dentistry And Dental Hygiene Page 7
Download a blank fillable Application For Dental Hygienist Licensure - Delaware Board Of Dentistry And Dental Hygiene in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Application For Dental Hygienist Licensure - Delaware Board Of Dentistry And Dental Hygiene with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5
6
7
8
9To ensure consideration of placement for the practical examination, the Board office must receive all of these
items no later than April 1 for the May examination or December 1 for the January examination:
•
Completed, signed and notarized application form
•
Fee payment
•
All required supporting documentation.
Applications that are not complete within 12 months of filing may be considered abandoned and discarded.
When your application is complete, please allow 4-6 weeks to receive your license.
AFFIDAVIT
I hereby apply to be considered for licensing as a Dental Hygienist by the Board of Dentistry and Dental Hygiene under
the standards, qualifications and procedures established under Title 24, Chapter 11, of the Delaware Code. I have read
the State statute governing dental hygienists in Delaware. I have also received and read the Board’s Rules and
Regulations regarding the practice of Dentistry and Dental Hygiene in Delaware. I understand that the Board may require
evidence additional to the material herein, including a written examination, and transcripts of academic training.
I hereby swear or affirm that the information contained in this application is correct and I understand that any intentionally
fraudulent information will be reported to the Attorney General.
Applicant Signature: __________________________________________________ Date: __________________
County of_______________________________ State of _________________________________
Sworn or affirmed before me a Notary Public this_______________ day of _____________________, 2_______.
Notary Signature: __________________________________________
SEAL
My commission expires on____________________
APPLICATIONS THAT ARE UNSIGNED, NOT NOTARIZED, INCOMPLETE OR SUBMITTED WITHOUT THE
REQUIRED FEE WILL BE REJECTED.
Revised 9/2017
ADVERTISEMENT
0 votes
Related Articles
Related forms
Application For Reinstatementlimited Liability Partnership - Delaware Division Of Corporations
Business
Application For Alcoholic Beverages License Form - Board Of License Commissioners, Anne Arundel County Maryland
Legal
Application For Auctioneer's License Form - Department Of Agriculture And Commerce - Mississippi
Legal
Application For A Preservation Permit - Metropolitan Government Of Nashville And Davidson County Form
Legal
Related Categories
Parent category: Legal