Dental Assisting Course Work Report - Canada

National Dental Assisting Examining Board – Graduate of a Canadian Program (Other than Dental Assisting) NDAEB Dental Assisting Course Work Report – Revised September 2021 - 1 - The Dental Assisting Course Work Report (DACWR) must be completed and submitted to the NDAEB for assessment along with your academic records. 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 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. • By completing this document, you are attesting to the fact that you have successfully completed all education and training necessary to be granted eligibility to write the NDAEB Exam and Clinical Practice Evaluation (CPE) (See theory and clinical requirements for each of the mandatory skills in this report). Name: _______________________________________________________________________ (Last Name or Family Name) (First or Given Name) ____________________________________________________________________________________________ (Alternate/Previous or Maiden Name) Date of Birth (yyyy-mm-dd) Mailing Address: ______________________________________________________________ Street/Avenue City ______________________________________________________________ Province/State Country Postal/Zip Code Telephone: ( Home ): ________________ ( Cell/Work ): ________________ ( E-Mail Address ): ____________________________