international applicant credential assessment submission checklist · pdf file ·...

INTERNATIONAL APPLICANT

CREDENTIAL ASSESSMENT SUBMISSION CHECKLIST

To determine exam eligibility, all applicants trained outside of Canada are required to follow the NDAEB Candidate Eligibility Assessment process by providing the following documents to the NDAEB office:

Checklist:

$150.00 international assessment fee, payable in Canadian dollars to NDAEB by money order or bank draft only. NDAEB does not accept credit or debit cards, personal cheques or cash.

Original report from one of the following credentials assessment agencies in Canada:

- International Credentials Evaluation Service (ICES) [Type of report required: Comprehensive Report]

- International Qualifications Assessment Service (IQAS) [Type of report required: Basic report with Dental Assisting Course Work Report submitted directly to IQAS by candidate for review]

- World Education Services (WES - Canada) (Type of report required: Course-by-Course Report)

Notes: 1. The original agency report must be received by NDAEB directly from the agency or a copy of the report submitted by the applicant

must be certified as a true copy of the original.

2. Applicants who have applied to the National Dental Examining Board of Canada (NDEB) and have been deemed eligible for exams may submit proof of NDEB exam eligibility in lieu of an agency report.

3. WES reports completed in the United States will not be accepted by the NDAEB.

Certified true copies of academic transcripts and diploma, translated to English or French if necessary, plus a certified true copy of the original document in another language if it was translated. Copies of academic records and other required documents must be certified or notarized as true copies in Canada by a notary public, lawyer or commissioner of oaths. True copies of documents certified at a provincial government office are also acceptable. Documents notarized in another country are not acceptable except those that were certified /notarized by Canadian staff at a Canadian embassy or consulate abroad.

A completed and signed Dental Assisting Course Work Report (DACWR). Applicants using either ICES or WES as their assessment agency or who submit NDEB proof of registration must submit the DACWR to NDAEB directly along with the other required documents. Applicants using IQAS for credentials assessment must submit the DACWR directly to IQAS for review. IQAS will forward to NDAEB with the assessment report.

In order to grant eligibility to graduates of a Dental Assisting program (or other formal allied dental health care program) achieved outside of Canada, the NDAEB requires a course outline provided by the candidate’s educational program clearly indicating the mandatory core skills required for NDAEB exam eligibility were included in that program. If an outline is not currently on file, the NDAEB will contact the program directly to request a program survey on behalf of the candidate. Applicants must provide the NDAEB with the school name, mailing address, email, and name of the program director/ instructor (or other appropriate administrator) of who will complete the survey. NOTE: If the program does not submit to the NDAEB office the required program survey, the NDAEB may not grant exam eligibility.

A Signed Consent for Personal Information form.

If the name appearing on the academic records or other documents is different than the name of the applicant, a certified true copy of a marriage or divorce certificate or sworn affidavit is required for NDAEB to verify and reconcile the name of the applicant with the name appearing on the documents being submitted.

National Dental Assisting Examining Board – International Applicant Submissions (Including USA)


NDAEB Dental Assisting Course Work Report – Revised September 2016

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The Dental Assisting Course Work Report (DACWR) must be completed and submitted to the NDAEB for assessment along with your

academic records. See the ‘International Applicant Credentials Assessment Submission Checklist’ above for details.

This report will be held on file pending receipt of the assessment agency report from ICES, IQAS or WES. PLEASE NOTE: If you choose

to have your academic records assessed by IQAS – you must submit the completed Dental Assisting Course Work Report (DACWR)

directly to IQAS for review. IQAS will send your DACWR and credentials assessment report to NDAEB with your permission. Reports

from ICES, IQAS or WES must be originals, received directly from the agency. A photocopy of the agency report submitted by the

applicant to NDAEB must be certified / notarized as a true copy of the original.

Dental Assisting Course Work Report

Instructions:

Please TYPE OR PRINT your responses. The report must be legible.

In the tables below, check () the topic areas covered by your course work in dental assisting (or other formal dental

training) and list the title of your courses.

Note that all topic areas that you report being covered by your course work, must be supported by official documentation

from a recognized academic institution and verified by ICES, IQAS or WES in their report.

By completing this document, you are attesting to the fact that you have successfully completed all education and trainingnecessary to be granted eligibility to write the NDAEB Exam and Clinical Practice Evaluation (CPE) (See theory and clinicalrequirements for each of the mandatory skills in this report).

Name: _______________________________________________________________________ (Last Name / Family Name) (First / Given Name)

_______________________________________________________________________ (Alternate/Previous / Maiden Name)

Mailing Address: ______________________________________________________________ Street/Avenue City

______________________________________________________________ Province/State Country Postal/Zip Code

Telephone: (Home): ________________ (Cell/Work): ________________ (E-Mail Address): ____________________________

International Credential Agency Used: ICES () _____ IQAS () _____ WES () _____ Date Applied: ______________

I am submitting proof of eligibility from the National Dental Examining Board of Canada (NDEB) () __________________

(Note: Your proof of eligibility document will be verified with the NDEB. False claims will forfeit your application)



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A. Please list the educational credential(s) you are presenting for assessment below:

Name of Certificate/Diploma/Degree Country Issuing Institution Dates

Issued

Length of

Program

Entrance

Requirements

Office Use

only

B. Check () the topic areas covered in your program and list the courses completed in each topic area. Note: there are nine (9)

mandatory intra-oral competencies required for exam eligibility. All are evaluated on the Clinical Practice Evaluation (CPE).

1. Conduct Appropriate to a Professional Setting – Check () those topic areas covered in your course work

()

Apply the principles of the Provincial/National Code of Ethics including self-reflection as to personal competence to perform assigned, legal duties

Practice according to the principles of dental jurisprudence and Provincial regulatory legislation regarding legal scope of practice

Apply time management, problem solving and critical thinking techniques Apply effective communication techniques with patients, care givers, service providers and dental health team members

including written and electronic formats Use professionally acceptable medical and dental terminology and abbreviations Recognize signs of suspected physical, sexual and emotional abuse or neglect and report suspected cases to the

appropriate authority Explain treatment to patients and/or caregivers and respond to questions to help resolve concerns in accordance with the

principles of obtaining informed consent Apply privacy policies according to the Personal Information Protection and Electronic Documents Act (PIPEDA) and

provincial privacy laws to all communications List the title of course(s) taken in the Conduct Appropriate to a Professional Setting below.

Course Title(s) Name of document where course

is listed Year course completed For office use only

2. Dental Sciences – Check () those topic areas covered in your course work

()

Oral Anatomy Describe, locate and identify structures of the oral cavity Describe, locate and identify soft tissue landmarks of the oral cavity Describe, locate and identify tooth anatomical landmarks Describe, locate and identify the tissues and supporting structures of the teeth State the functions of teeth and their supporting structures



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Anatomy of the Head and Neck Identify and locate the bones of the head and describe their structure and function Identify anatomical landmarks of the head Identify and describe the parts of the temporomandibular joint (TMJ), it’s movements and disorders

Identify the muscles of the face and oral cavity and describe their function Identify and locate the salivary glands and ducts and describe their function Identify and locate the sinuses Identify and describe the innervations of the teeth and surrounding tissue of mandibular and maxillary arches Identify and locate the lymph nodes of the head and neck and describe their functions

Tooth Development and Eruption Describe oral facial development including the teeth Describe tooth eruption and exfoliation patterns

Oral Pathology Describe genetic, developmental and acquired anomalies/pathologies of the hard and soft tissues of the oral cavity Describe the etiology and progression of hard and soft tissue lesions

Microbiology Describe and identify diseases related to micro-organisms including bacteria, spores, viruses, fungi, protozoa and prions Describe the routes of disease transmission

Pharmacology Describe the effects and interactions of non-prescription, prescription and controlled drugs on patient care and safety issues Explain the purpose and process of recording medications including dosages and frequency taken Explain the indications for pre-medication prior to dental treatment Interpret information regarding medications taken for medical conditions Explain the clinical indications for antibiotic prophylaxis prior to invasive procedures

List the title of course(s) taken in the Dental Sciences below.



3. Clinical Support Procedures – Check () those topic areas covered in your course work

()

Principles of Asepsis Explain the rationale for infection prevention procedures in the dental office Explain approved methods for the prevention of disease transmission for patients and dental healthcare providers including:

standard infection control procedures sanitation, disinfection, sterilization and storage quality assurance protocols for instrument processing equipment and procedures in accordance with manufactures’

instructions personal protection equipment immunization



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Discuss the ethical and legal considerations of treating patients with infectious diseases Employ accepted safety standards for infection prevention and handling of hazardous materials and substances in the

workplace according to Workplace Hazardous Materials Information System (WHMIS) and Occupational Health and Safety Regulations

Employ ethical protocols for injury prevention, exposure control, post-exposure first-aid and maintenance of employee health records

Explain protocols used to reduce biofilm within dental unit waterlines and evacuation systems Equipment and Supplies Identify, operate and maintain dental instruments and equipment Select and prepare supplies

Team Ergonomics Apply principles of ergonomics in positioning the patient/operator/dental assistant throughout all procedures Apply the principles of instrument and material transfer to support procedural efficiency and patient safety Use appropriate instrumentation techniques to ensure procedural efficiency and patient safety

List the title of course(s) taken in the Clinical Support Procedures below.



4. Patients Records – Check () those topic areas covered in your course work

()

Apply protocols to comply with legal requirements for maintaining and transferring patient records/documents in both paper-based and electronic systems

Complete and update patient records/documents using paper-based and electronic systems to include: personal history health history intra-oral/extra-oral examination oral hygiene indices diagnostic study models and bite registration radiographs photographs vital signs consent forms care/treatment plan and progress notes/treatment records/medications administered

Relate patient health history information to treatment Use professionally acceptable terminology, charting symbols, abbreviations and tooth numbering systems



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List the title of course(s) taken in Patient Records below.



5. Patient Care Procedures - Check ( ) those topic areas covered in your course work

()

Obtain Vital Signs Explain the rationale for obtaining vital signs Describe procedures for measuring pulse, temperature, blood pressure and respiration with reference to “normal” ranges Describe factors that affect vital signs Obtain vital signs including blood pressure, pulse, respirations and temperature

Collect Diagnostic Information Assist with diagnostic procedures:

State the types of and provide the rationale for performing diagnostic procedures Prepare and transfer equipment and supplies for diagnostic procedures

Obtains preliminary impressions for study models: State the rationale for obtaining preliminary impressions and bite registrations for the fabrication of study models Select and prepare equipment and supplies specific to the patient’s dentition and anatomy Manipulate preliminary impression material Obtain mandibular and maxillary preliminary impressions following procedural steps * Evaluate impressions Disinfect impressions Prepare impressions for storage and pouring Obtain, evaluate and disinfect simple bite registrations Provide pre-operative, operative and post operative information/instructions

*Mandatory intra-oral skill evaluated on Clinical Practice Evaluation (CPE)

Produce digital and conventional film based radiographic images: Describe components of x-ray machines and their functions Describe factors that affect the quantity and quality of the x-ray beam Describe composition of dental film and types of digital imaging receptors Describe components of the dental film packet and their purposes Describe care, storage and handling of dental films and digital imaging receptors Describe the biological effects of radiation exposure Describe personal radiation monitoring devices and procedures Describe the types of radiographic images and the rationale for their use Provide pre-exposure information and instructions to the patient Apply principles of extra-oral and intra-oral radiographic techniques Select and prepare equipment and supplies Expose prescribed radiographic images in accordance to A.L.A.R.A. principles when using conventional film

based or digital radiography * Apply quality assurance standards Process exposed conventional films Explain causes and corrective measures for radiographic image exposure, processing and handling errors Describe radiographic image duplicating procedures Evaluate radiographic images for technical quality, accuracy and diagnostic acceptability Describe the difference between radiolucent and radiopaque



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Identify and describe anatomical landmarks and dental anomalies on radiographic images Mount, label and store/save radiographic images Differentiate between direct and indirect digital imaging


Emergency Care Assist with the assembly and maintenance of emergency supplies, drugs and equipment Assist in the prevention and management of dental office emergencies Identify and interpret signs and symptoms of medical conditions which may require emergency care Assist in the management and treatment of dental emergencies

Management of Patients with Special Needs Schedule appointments to accommodate patients with special needs Adapt procedures according to patients’ physical needs and mobility limitations Provide information and instructions to patients and care givers with consideration of their cognitive level and

communication ability

Anaesthesia and Pain Management Assist with the administration of topical and local anaesthetic:

Identify precautions during application of topical and administration of local anaesthetic Describe injection techniques and locate injection sites Describe signs and symptoms of adverse reactions to anaesthetic Describe procedure for application of topical and administration of local anaesthetic Prepare equipment and supplies for topical and local anaesthetic administration Monitor patient for signs of anxiety and adverse reactions to anaesthetic Apply techniques for the safe handling of needles Manage needlestick injuries according to protocols Provide pre-operative, operative and post operative information/instructions for administration of topical and local

anaesthetic Applies topical anaesthetic agents as prescribed: *

Select and prepare equipment and supplies for treatment Prepare injection site and apply the topical anaesthetic according to manufacturer’s instructions Assess tissue for adverse reactions and apply corrective measures


Assist with sedation and general anaesthesia: Differentiate between levels of sedation and general anaesthesia Identify contra-indications for the administration of sedation and anaesthesia and monitor patient for adverse

reactions to each Describe signs and symptoms of adverse reactions to anaesthesia and sedation Prepare equipment and supplies and monitor patient for signs of adverse reactions related to sedation and

anaesthesia Record and monitor vital signs before, during and after sedation and anaesthesia Provide verbal/written, pre-operative, operative and post operative and home care information/instructions

Moisture Control Techniques State indications and contra-indications for various moisture control techniques Select equipment and supplies, prepare for and assist with moisture control Place and remove moisture control equipment and supplies Apply and removes dental dam: *

Select and prepare equipment and supplies considering the patient’s dentition and prescribed procedure Assist with the application and removal of dental dam Apply and remove dental dam following procedural steps Evaluate dental dam placement and isolation effectiveness Identify and correct dental dam positioning and isolation errors Provide pre-operative, operative and post operative information/instructions




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Position oral evacuation to maintain a dry operating field and patient comfort

Operative Dentistry Procedures Identify cavity/restoration classifications Use terminology associated with cavity preparation and restorations Assist with the application of treatment liners:

Describe the functions and benefits of liners, bases, varnishes, cements and bonding materials and the indications and contra-indications for their use

Describe the components of bonding systems, their uses, effects and precautions List the order of placement and location for treatment liners Prepare, manipulate and transfer treatment liner, acid etchant and bonding materials according to manufacturer’s

instructions Apply treatment liners (no pulpal involvement), acid etch and bonding materials: *

Select and prepare equipment and supplies Apply treatment liners, acid etchant and bonding materials following procedural steps Evaluate placement according to criteria and make modifications as necessary


Assist with the application and removal of matrix systems and wedges: State the rationale for using matrix systems and wedges Select and assemble matrix system and wedge(s) for prescribed restorative procedures Assist with placement and removal of matrix system and wedge(s)

Apply and remove matrix system and wedge(s): * Select and prepare equipment and supplies Apply matrix system and wedge(s) following procedural steps Evaluate placement according to criteria Correct application errors Remove matrix system and wedge(s) following procedural steps Evaluate removal according to criteria


Assist with preparation and placement of permanent restorative materials: Describe the properties and explain the rationale for the use of amalgam and tooth-coloured restorative materials Prepare equipment and supplies and assist with amalgam placement and finishing procedures, observing mercury

hygiene practice Describe tooth-coloured restorative materials and their polymerization Prepare equipment and supplies and assist with placement and finishing of tooth-coloured restorative materials Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions

Dispense and/or mix temporary restorative materials: Explain the rationale for using various types of temporary restorative materials Prepare equipment and supplies and assist with placement of temporary restorative materials Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions

Assist with tooth whitening techniques: State indications and contra-indications for whitening of vital and non-vital teeth Describe tooth whitening materials and techniques Describe the complications which may result from tooth whitening Prepare equipment and supplies and assist with tooth whitening Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions

Assist with placement of dental implants State indications and contra-indications for the placement of the various types of dental implants Describe the diagnostic tests and information necessary to prepare for dental implant placement Prepare equipment and supplies and assist with the placement of dental implants Describe complications that may arise from the placement of dental implants Provide verbal/written, pre-operative, operative, postoperative and home care instructions



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Oral and Maxillofacial Surgical Procedures State indications and contra-indications for surgical procedures Prepare equipment and supplies and assist with surgical procedures Monitor patient’s condition prior to, during and after surgical procedures Describe complications which may arise from surgical procedures and their treatment Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions Perform suture removal

Identify various suture materials and techniques Assess soft tissue for signs of healing, infection or post-operative complications and record/report to dentist Evaluate site to determine where to cut suture Cut and remove suture Provide patient with post-operative care instructions following suture removal Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions

Endodontic Procedures State indications and contra-indications for endodontic procedures Describe diagnostic tests to determine tooth vitality Prepare equipment and supplies and assist with endodontic procedures in both primary and permanent dentitions Describe complications which may arise from endodontic procedures and their treatment Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions

Periodontic procedures State indications and contra-indications for periodontic procedures Describe periodontal screening and recording Prepare equipment and supplies and assist with periodontic procedures Describe complications which may arise from periodontic procedures and their treatment Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions

Prosthodontic Procedures Differentiate between fixed and removable prostheses State indications and contra-indications for fixed and removable prostheses Prepare equipment and supplies and assist with prosthodontic procedures Describe the dental assistant’s role in coordinating the preparation, packaging, delivery and reception of lab cases Describe complications which may arise from prosthodontic procedures and their treatment Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions

Orthodontic Procedures Describe and classify occlusion and malocclusion according to Angle’s Classification Use terminology associated with malaligned teeth and arches Identify and describe factors affecting occlusion Differentiate between fixed and removable orthodontic appliances State indications and contra-indications for orthodontic treatment Prepare equipment and supplies and assist with orthodontic procedures Describe the dental assistant’s role in written and verbal communication with the dental lab Coordinate the preparation, packaging, delivery and reception of lab cases Describe complications which may arise from orthodontic procedures and their treatment Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions



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List the title of course(s) taken in Patient Care Procedures below.



6. Practice Management Procedures – Check ( ) those topic areas covered in your course work

()

Manage and maintain filing, recall and inventory systems in both paper-based and electronic systems Manage patient appointments, referrals and consultations Manage and maintain financial records in both paper-based and electronic systems

List the title of course(s) taken in Practice Management Procedures below.



7. Laboratory Procedures - Check ( ) those topic areas covered in your course work

()

Process impressions, trim and finish models Fabricate appliances and trays Maintain supplies and instruments, operate equipment and manipulate materials following protocols for safety and asepsis

List the title of course(s) taken in Laboratory Procedures below.





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8. Preventive Procedures –Check ( ) those topic areas covered in your course work

()

Provide Oral Hygiene Instruction Describe the periodontal disease process and the factors affecting its development and progress Describe the caries process and the factors affecting its development and progress Describe the indications, contra-indications, types, purposes and methods of applying disclosing agents List and describe oral hygiene indices Apply the principles of instruction and learning to individuals and groups Collect data to assess patient needs using methods such as: plaque/biofilm indices, disclosing agents in addition to

observation of tissue condition Develop oral hygiene goals using patient centered approach Select and demonstrate oral care aids specific to oral conditions to achieve goals Apply disclosing agents Evaluate outcomes of oral hygiene instruction, provide feedback and make necessary modifications

Provide Nutritional Counseling Relative to Oral Health List nutrients, their sources, functions and effects Collect data to assess patient’s nutritional needs Develop dietary goals using patient centered approach Make dietary recommendations specific to oral health conditions utilizing “Canada’s Food Guide for Healthy Living” Evaluate nutritional counseling outcomes, provide feedback and make recommendations and/or modifications

Performs Selective Coronal Polishing * State the rationale, indications and contra-indications for selective coronal polishing Differentiate between intrinsic and extrinsic stain Describe the etiology of stain Select and prepare equipment and supplies specific to the patient’s needs Remove stain according to procedural steps Evaluate selective coronal polishing outcomes and make any necessary modifications Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions

*Mandatory intra-oral skill evaluated on Clinical Practice Evaluation (CPE) Apply Anti-Cariogenic Agents * State the rationale, indications and contra-indications for application Describe the effects of anti-cariogenic agents on tooth structure Describe methods for topical application of anti-cariogenic agents Assess patient needs for appropriate anti-cariogenic agents selection Select and prepare equipment and supplies for various types of anti-cariogenic agents specific to the patient’s needs Apply anti-cariogenic agents according to manufacturer’s instructions Evaluate anti-cariogenic agent outcomes, provide feedback and make necessary recommendations and/or modifications Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions

*Mandatory intra-oral skill evaluated on Clinical Practice Evaluation (CPE) Apply pit and fissure sealants * State the rationale, indications and contra-indications for application Describe sealant materials and their polymerization Select and prepare equipment and supplies for prescribed treatment Evaluate the effectiveness of various moisture control techniques Prepare prescribed surfaces and apply sealant material according to manufacturer’s instructions Evaluate sealant placement according to criteria and make modifications if required Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions




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Applies desensitizing agents State the rationale, indications and contra-indications for application Describe desensitizing agents and their mode of action Select and prepare equipment and supplies for prescribed treatment Prepare prescribed surfaces and apply material according to manufacturer’s instructions Evaluate the application of the desensitizing agent according to criteria and make modifications if required Provide verbal/written, pre-operative, operative, and post-operative and home care information/instructions

Performs tooth whitening using trays State the rationale, indications and contra-indications for patient use Select and prepare equipment and supplies Determine existing tooth shade prior to whitening Demonstrate and deliver the product to the patient according to manufacturer’s instructions Identify and explain effects of improper use of whitening products Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions

List the titles of course(s) taken in Preventive Procedures below.



9. In-Office Practicum/Externship Experience

Please describe the in-office practicum or externship (if applicable) that you completed prior to graduation from your program of study:



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CANDIDATE DECLARATION:

I declare that the information I have provided is factual with respect to the education and training I have completed in

another country. I understand that to be eligible for the NDAEB certificate, I must be trained to perform the mandatory

core skills (intra- oral duties) as the operator and that I will be required to have my clinical skills evaluated by

the NDAEB confirming my clinical competence. I understand that if I have not received the required education and

training to meet the NDAEB standard, the NDAEB will direct me to attend an educational upgrade program at a Canadian

educational institute before being granted exam eligibility. I acknowledge the mandatory Intra-oral skills evaluated on the

Clinical Practice Evaluation are:

Skill 1 – Exposes Dental Radiographs Skill 2 – Obtains Preliminary Impressions for study casts Skill 3 – Applies and Removes Dental Dam Skill 4 – Performs Selective Coronal Polishing (Rubber Cup) Skill 5 – Applies Treatment Liners (No Pulpal Involvement) Skill 6 – Applies and Removes Matrix Band and Wedge Skill 7 – Applies Fluoride (Tray Method) Skill 8 – Applies Pit and Fissure Sealants (Cotton Roll Isolation) Skill 9 – Applies Topical Anesthetic I further acknowledge that if I am applying from outside Canada, the NDAEB written examination and CPE are available

only in Canada and that the granting of exam eligibility by the NDAEB in no way assures or implies acceptance for

immigration or entry to Canada, nor does it guarantee the likelihood or possibility of attaining employment, registration

or licensure as a dental assistant in a Canadian province. (See notes below).

Candidate Signature Date

Notes:

1. For information regarding Canadian immigration policy and procedures, please contact Canadian immigration

authorities.

2. For information regarding registration/licensure/certification as a dental assistant in a Canadian province, contact

the provincial Canadian Dental Assisting Regulatory Authority (CDARA) prior to submitting your application to the

National Dental Assisting Examining Board. See the NDAEB website: www.ndaeb.ca for CDARA contact

information.

3. International applicants may choose voluntary education upgrading in the intra-oral skills in lieu of the Clinical

Practice Evaluation (CPE). Voluntary upgrading must be completed at a Canadian educational institution listed on

the NDAEB website and include all skills evaluated on the CPE. We recommend attending programs accredited by

the Commission on Dental Accreditation of Canada for labour mobility purposes. See the NDAEB website:

www.ndaeb.ca for a list of exam eligible schools.

http://www.ndaeb.ca/

http://www.ndaeb.ca/



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We require your informed consent before registering you for the NDAEB Exam or Clinical Practice Evaluation.

Please read the following statements and sign below.

Consent for Personal Information

I understand that to register for the NDAEB written exam or Clinical Practice Evaluation, the NDAEB will collect personal information about me including: my name, photograph, mailing address, my credit card information (if paying by Visa or Master Card), educational transcripts/diplomas or letter(s) from my school confirming my enrollment in or graduation from an eligible dental assisting educational program. I understand that if I received my dental assisting (or allied) education outside Canada, the required documents will include, but may not be limited to, report(s) from third parties such as translators and international credentials evaluation agencies confirming my academic records. I understand that if I request special exam accommodations for medical or other reasons, I must provide the NDAEB with reports or other documents from third parties such as, educational counselors, psychologists or physicians to support my request. I understand that if I request a special exam sitting date for religious reasons, the NDAEB will require me to provide written confirmation from a religious leader before considering my request. I understand that the NDAEB may verify the authenticity of any documents submitted in support of my application with the originating organization. I have read the NDAEB policy regarding the collection, use, disclosure and protection of my personal information and I have been provided with contact information and telephone number should I have questions or concerns. I understand that should I request my written examination paper after the exam, I will receive a copy of my personal answer sheet which does not include NDAEB test items (questions). I understand that, in the interest of public safety, the NDAEB may release any of my name, result(s) of my NDAEB written examination or Clinical Practice Evaluation (CPE), my NDAEB Certificate Number, the date of my exam sitting, the date of my taking the CPE and the date of completion of my Transfer of Credentials (ToC) to the Dental Assisting Regulatory Authority (DARA) in the province in which I wrote the exam/ and or took the CPE, to any other DARA requesting information about me and to any other DARA to which the NDAEB considers, in its sole discretion, that such disclosure is appropriate. I understand that the NDAEB will retain my personal information indefinitely. I understand that should the NDAEB come into possession of any personal information about me in addition to the information referred to above, such information shall not be disclosed without my written consent. I hereby give my consent to the NDAEB to collect, use, disclose and protect my personal information as set out in NDAEB policy.

Signature:____________________________________________________ Date:_____________________ Printed Name: ________________________________________________ Notes made by NDAEB: ________________________________________

205 – 2255 St. Laurent Blvd. Ottawa, ON K1G 4K3

Tel: (613) 526-3424 Fax: (613) 526-5560 Email: [email protected]

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