Download orthodontic module

ORTHODONTIC MODULE
APPLICATION FORM
RETURN YOUR APPLICATION AND SUPPORTING DOCUMENT IN PERSON, FAX, OR BY MAIL TO: (by TBA)
Certified Dental Assistant Department, Attention: Carrie Tepper
[email protected]
Okanagan College
1000 KLO Road
Kelowna, BC V1Y 4X8
Ph: (250) 862-5424
Fax: (250) 862-5633
Full Legal Name:
(include first name and all middle names - no initials)
Address:
Street
Province:
City/Town
Postal Code __________________ Phone: (Home)
Email address:
Birthdate (mm/dd/yyyy):
CDA Registration #: _____________________
EMPLOYER:
Certified Orthodontist?
Employer Phone:
 Yes
 No
Employer Fax:

ORTHODONTIC MODULE PRE-REQUISITE:
You will be required to provide the following:
1. Proof of current practising license as a Certified Dental Assistant with College of Dental Surgeons of BC or current
practising license as a Registered Dental Hygienist with the College of Dental Hygienists. (copy of license must be
attached).
2. Applicant must have 1 year experience and/or currently be working in an office that requires them to perform ortho
duties or be employed by an orthodontist.
*The above pre-requisite information must accompany this application or your application will not be considered.
Distance Education (THEORY) start date:
TBA (Fall 2011)
Review Seminar/Clinical Orientation:
OC-KLO Campus Room H132
TBA
9:00 am – 12:00 am
Final Theory Exam:
OC-KLO Campus Room H132
TBA
9:00 am – 12:00 am
Clinical:
OC – KLO Campus Room H130/H132
TBA (2 weekends)
8:00 am – 5:00 pm
You will be notified by the Certified Dental Assistant Department if you are one of the successful applicants.
(Please be sure that you have provided us with accurate information regarding your telephone and/or facsimile
number).
REGISTRATION AND FULL PAYMENT OF COURSE FEE: $1,225.00 PAYABLE TO OKANAGAN COLLEGE MUST THEN BE
RECEIVED AT THE Continuing Education Department; (862-5480) BY TBA
pros\application_form-ORTHOfeb08.doc