Dentist Faculty Member License Instructions printable pdf download

EXAS

TATE

OARD OF

ENTAL

XAMINERS

333 Guadalupe Tower 3, Suite 800

Austin, Texas 78701-3942

Phone: (512) 463-6400 | Fax: (512) 463-7452

DENTIST FACULTY MEMBER

E-Mail: licensinghelp@tsbde.texas.gov

LICENSE INSTRUCTIONS & APPLICATION

Website:

General Qualifications for Licensure

1. Be at least 21 years of age.

2. Be of good moral character and professional fitness, which is demonstrated by patterns of personal, academic and

occupational behaviors, including final or pending disciplinary action on any occupational license in any jurisdiction,

which, in the judgment of the Board, indicate honesty, accountability, trustworthiness, reliability, integrity, and ability.

3. Pay all required fees. There is no fee for Military Active Duty, Retirees or Military Spouses. Payment for national and

regional examinations and the Jurisprudence Assessment is still required.

4. Submit an application for licensure.

5. Provide information and documents as requested by the TSBDE.

Application and Supporting Documentation Requirements

1. Official school transcript showing proof of graduation from a Commission on Dental Accreditation-accredited (CODA)

dental school. If mailing a photo copy of the official transcript, it must be notarized.

2. Endorsement from the Dean, Department Chair or Program Director of the employer-school verifying full-time or part-time

salaried faculty position at a CODA-accredited dental school.

3. National Practitioner Data Bank (NPDB) Self-Query. All applicants are required to complete a self-query of the NPDB.

The report results must remain in the original sealed envelope and be attached to your application to the

TSBDE. NPDB self-query reports are valid for 30 days. NPDB charges a minimal fee to furnish this information. You can

contact the NPDB at Post Office Box 10832, Chantilly, VA 22021, telephone number (800) 767-6732, or

website

4. American Association of Dental Boards (AADB) Clearinghouse Self-Query. Applicants are required to complete a self-

query of the AADB Clearinghouse. The report results must remain in the original sealed envelope and be attached to

your application to the TSBDE. AADB charges a minimal fee to furnish this information. The AADB self-query form can

be downloaded from the AADB website at https:// The AADB

self-query form should be mailed to: American Association of Dental Boards, 211 East Chicago Avenue, Suite 760,

Chicago, IL 60611. The AADB telephone number is (312) 440-7464.

5. Completion of the TSBDE Jurisprudence Assessment dated within one year immediately prior to application for licensure.

(Fee required)

6. Photo copy of current Basic Life Support (BLS) CPR Card.

7. Photo copy of Social Security Card.

8. Military should submit either a copy of Change of Station Orders, Identification Card or document showing proof of

Honorable or General discharge.

Application Instructions

Attach the following documents and your payment to this application and mail to the TSBDE office at the address above.

 Official transcript showing proof of graduation from a CODA-accredited Dental School.

 Photo copy of Social Security Card.

 Photo copy of Basic Life Support CPR Card.

 TSBDE Jurisprudence Assessment Certificate of Completion.

 AADB and NPDB Self-Query Report Results. (Must remain in their sealed envelope)

 Proof of military status. (If applicable)

Dentist Faculty Member License Application

February 1, 2016

Dentist Faculty Member License Instructions

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