Apply to Dental Depot Academy's
Dental Assistant Program

Application Date*
Program Term*
Student Information
Student's Name*
First Middle Last
Date of Birth*
Current Mailing Address*
Street Address Address Line 2 City State ZIP Code
Home Phone*
Cell Phone*
Email*
Referral Source*
Have you previously applied to the Dental Depot Academy of Dental Assisting?*
- Yes
- No
Education Information
Please select High School or GED and complete the appropriate information.*
- High School
- GED
Attach copy of HS Diploma/Transcript or GED*
Please answer the questions below
Why do you want to be a Dental Assistant?*
What interests you about Dental Assisting/Dentistry?*
I have read and understand the admission criteria for Dental Depot Academy of Dental Assisting. I understand it is my responsibility to meet all application criteria. I understand falsification of any information may lead to disqualification or dismissal from the Academy. I understand that failure to sign and date this application renders my application ineligible.
E-Signature*
Date
Be sure to have your application in prior to the deadline to be considered for an interview. The application deadlines are located on the Dental Depot Academy of Dental Assisting website. If selected for an interview, you will need to bring identification on the day of the interview.

Have Questions About Dental Depot Academy?

We’re here to help. Send us an email at rgraham@dentaldepot.net or call at 405-296-6123