National Dental Assisting Examining Board – International Applicant Submissions (Including USA) NDAEB Dental Assisting Course Work Report – Revised January 2023 - 1 - 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 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 / 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. (NDAEB will revoke exam eligibility of candidates not confirmed NDEB eligible, and false claims will forfeit your application.)
RkJQdWJsaXNoZXIy MzA1NjE=