Online Form Usage and Navigation Instructions*

Consent for Personal Information

Please read and complete the following form regarding the processing of personal information by the NDAEB for purposes related to the assessment of your application and administration of examinations.

I understand that for the purpose of assessing my application to register for and participate in the Written Examination and/or Clinical Practice Evaluation (CPE), the NDAEB collects personal information including: my name, photograph (for identification purposes at the examination facility), mailing address, 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 also 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 may be required to 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, I may be required to provide written confirmation from a religious leader before the NDAEB considers my request.

I have read the NDAEB Privacy Policy regarding the collection, use, disclosure and protection of my personal information and I have been provided with contact information and a telephone number should I have questions or concerns. The NDAEB Privacy Policy, which governs the NDAEB’s practices with respect to the collection, use and disclosure of personal information, is readily available at https://ndaeb.ca/privacy-policy/.

As indicated in the NDAEB Privacy Policy, I understand that I may request access to my personal information and request that corrections be made. I may also refuse to provide some personal information or request to withdraw my consent; however, some personal information is necessary to fulfill the NDAEB’s mandate. As such, the NDAEB may be unable to provide its services if necessary personal information is not provided.

I understand that, as part of the mandate and in the interest of public safety, the NDAEB may disclose personal information, which may include my name, my pass/fail result(s) of the NDAEB Written Examination and/or Clinical Practice Evaluation (CPE), my NDAEB Certificate Number, the date of my examination sitting, the date of my taking the CPE, and the date of the completion of my Transfer of Credentials (ToC)to the Canadian Dental Assisting Regulatory Authority (CDARA) in the province in which my address is listed, the province in which I wrote the exam and/or took the CPE, to any other CDARA requesting information about me, and to any other CDARA to which the NDAEB considers, in its sole discretion, that such disclosure is appropriate.

I understand that the NDAEB may retain my personal information as long as is necessary to meet the requirements of the NDAEB mandate. I hereby give my consent to the NDAEB to collect, use, disclose and protect my personal information as set out above.

You have selected that you do not consent to the processing of your personal information by the NDAEB.

As a result, the NDAEB is unable to continue with your registration. You may wish to review the Privacy Policy and/or the above Consent for Personal Information again. If you do not wish to proceed, you may close your application.

Please contact the NDAEB office at 613-526-3424 should you have any questions.

Information Officer (Responsible for privacy compliance):

NDAEB
Stephen Grundy, CAO/Registrar
204 - 2283 St. Laurent Blvd.
Ottawa, ON K1G 5A2
Phone: 613-526-3424
Fax: 613-526-5560
E-mail: office@ndaeb.ca

Personal Information

The NDAEB Certificate is an official document used for the registration/licensure of dental assistants in Canada. Your name will appear on all NDAEB correspondence and your certificate exactly as entered below. Use only your legal given name(s) and surname as shown on your valid government-issued photo identification, which must be presented on the day of the CPE and Theory Exam. Do not use nicknames. If the name on your academic records differs from the name provided below (e.g., abbreviated, initials only, or different spelling), you must submit a notarized document and, if applicable, a notarized translation as proof of your name change (e.g., marriage certificate, affidavit).

Program Survey

In order to assess the eligibility of graduates of non-registered Dental Assisting / Hygiene programs (or other allied dental health care programs), the NDAEB requires program information provided by the educational institute clearly indicating the mandatory core skills required for NDAEB exam eligibility were included in that program.

Please provide NDAEB with the following institutional contact information.

Credential Assessment Agency

Please provide the following details on the Credential Assessment Agency you will be using to verify your credentials.

Dental Assisting Course Work Report (DACWR)

Please provide details on the dental health program that you have completed in order to determine your eligibility with the NDAEB.

A. Educational Credential(s)

1. Conduct Appropriate to a Professional Setting

Credential Assessment Supporting Documents

In this section, you will upload your proof of completion for each of the dental health programs you have entered to determine NDAEB eligibility. You may also be required to submit additional documents depending on the agency you have selected to assess your credentials.

Candidate Declarations

Please read and acknowledge the following candidate declarations.

I declare that the information that I have provided is factual with respect to the education and training I have completed as a graduate of a non-registered program.

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 educational upgrading at an educational institute accredited by the Commission on Dental Accreditation of Canada (CDAC) before being granted NDAEB eligibility.

I acknowledge that the mandatory Intra-oral skills evaluated on the Clinical Practice Evaluation (CPE) are:

1. Exposes Digital Radiographic Images
2. Obtains Impressions for Study Casts
3. Applies and Removes Dental Dam
4. Selective Coronal Polishing
5. Applies Treatment Liners
6. Applies and Removes Matrix Band and Wedge
7. Applies Anti-Cariogenic Topical Fluoride Gel
8. Applies Pit and Fissure Sealants
9. Applies Topical Anesthetic

I confirm that I am not eligible to register for the NDAEB Clinical Practice Evaluation (CPE), nor the NDAEB Theory Exam (TE), until I receive an official NDAEB eligibility letter.

I further acknowledge that if I am applying from abroad, the NDAEB Clinical Practice Evaluation (CPE) and the NDAEB Theory Exam (TE) are available only in Canada and that the granting of NDAEB eligibility 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.

Below is a summary of your application selections. Please review carefully and make any necessary changes and/or correct missing information using the "Previous" button at the bottom of this page. Do NOT use the back button on your browser to correct selections on your application. When you have completed your review, you may select the "Next" button.

Signature:
{Signature::47}

Printed Name: {Printed Name::200}

Signature Date: {Date::201}

Withdrawal Status

Have you previously applied to the NDAEB and/or withdrawn/cancelled/did not complete the application process or have a pending application status?

{Withdrawal Status:413}

NDAEB ID (if applicable): {NDAEB ID:414}

Legal Name

First Name: {Name (First):7.3}

Middle Name: {Name (Middle):7.4}

Last Name: {Name (Last):7.6}

Alternate/Previous/Maiden Name (if applicable): {Alternate/Previous/Maiden Name:329}

Proof of Name Change Uploaded (if applicable):

{Proof of Name Change:215}

Profile Photo Uploaded

{Profile Photo:415}

Mailing Address

{Home Address (Street Address):5.1}
{Home Address (Address Line 2):5.2}
{Home Address (City):5.3}, {Home Address (State / Province):5.4} {Home Address (ZIP / Postal Code):5.5}

{Home Address (Country):5.6}

Date of Birth

{Date of Birth:203}

Email(s)

Primary Email: {Email Address:8}

Alternate Email (if applicable): {Alternate Email Address:65}

Phone Number(s)

Primary Phone: {Primary Phone:80}

Alternate Phone (if applicable): {Alternate Phone Number:81}

Dental Health Credentials Declaration

{Dental Health Care Credentials Declaration:538}

Dental Health Credentials

{Dental Health Credential(s):338}

Dental Health Credentials Verification Program/Agency

{Name of Director/Program Head:547}, {Name of University/College/Insititute:546}, {:548}, {:549} {Credential Assessment Agency:213}

Diploma(s) Uploaded

{Diploma(s):240}

Final Transcript(s) Uploaded

{Final Transcript(s):241}

Other Dental Health Program Supporting Document(s) Uploaded (if applicable)

{Other Dental Health Program Supporting Document(s):242}

Signature:
{Signature:255}

Printed Name: {Printed Name::248}

Signature Date: {Date::249}

{Conduct Appropriate to a Professional Setting Course(s):340}

You have selected the following skills out of 8 mandatory skills in this section:

{Conduct Appropriate to A Professional Setting:332}

{Dental Sciences Course(s):343}

Oral Anatomy

You have selected the following skills out of 5 mandatory skills in this section:

{Oral Anatomy:342}

Head and Neck Anatomy

You have selected the following skills out of 8 mandatory skills in this section:

{Head and Neck Anatomy:357}

Tooth Development and Function

You have selected the following skills out of 2 mandatory skills in this section:

{Tooth Development and Function:358}

Oral Pathology

You have selected the following skills out of 2 mandatory skills in this section:

{Oral Pathology:359}

Microbiology

You have selected the following skills out of 2 mandatory skills in this section:

{Microbiology:360}

Pharmacology

You have selected the following skills out of 5 mandatory skills in this section:

{Pharmacology:361}

{Clinical Support Course(s):345}

Principles of Asepsis

You have selected the following skills out of 10 mandatory skills in this section:

{Principles of Asepsis:344}

Equipment and Supplies

You have selected the following skills out of 2 mandatory skills in this section:

{Equipment and Supplies:363}

Team Ergonomics

You have selected the following skills out of 3 mandatory skills in this section:

{Team Ergonomics:364}

{Patient Records Course(s):347}

You have selected the following skills out of 13 mandatory skills in this section:

{Patient Records:398}

{Patient Care Procedures Course(s):349}

Obtain Vital Signs

You have selected the following skills out of 4 mandatory skills in this section:

{Obtain Vital Signs:348}

Collect Diagnostic Information

You have selected the following skills out of 32 mandatory skills in this section:

{Collect Diagnostic Information:368}

Emergency Care

You have selected the following skills out of 4 mandatory skills in this section:

{Emergency Care:369}

Management of Patients with Special Needs

You have selected the following skills out of 3 mandatory skills in this section:

{Management of Patients with Special Needs:370}

Anaesthesia and Pain Management

You have selected the following skills out of 18 mandatory skills in this section:

{Anaesthesia and Pain Management:372}

Moisture Control Techniques

You have selected the following skills out of 10 mandatory skills in this section:

{Moisture Control Techniques:371}

Operative Dentistry Procedures

You have selected the following skills out of 36 mandatory skills in this section:

{Operative Dentistry Procedures:373}

Oral and Maxillofacial Surgical Procedures

You have selected the following skills out of 11 mandatory skills in this section:

{Oral and Maxillofacial Surgical Procedures:374}

Endodontic Procedures

You have selected the following skills out of 5 mandatory skills in this section:

{Endodontic Procedures:375}

Periodontic Procedures

You have selected the following skills out of 5 mandatory skills in this section:

{Periodontic Procedures:376}

Prosthodontic Procedures

You have selected the following skills out of 5 mandatory skills in this section:

{Prosthodontic Procedures:378}

Orthodontic Procedures

You have selected the following skills out of 10 mandatory skills in this section:

{Orthodontic Procedures:377}

{Practice Management Course(s):381}

Practice Management Procedures

You have selected the following skills out of 3 mandatory skills in this section:

{Practice Management Procedures:380}

{Laboratory Procedures Course(s):384}

Laboratory Procedures

You have selected the following skills out of 3 mandatory skills in this section:

{Laboratory Procedures:383}

{Preventitive Procedures Course(s):465}

Provides Oral Hygiene Instruction

You have selected the following skills out of 10 mandatory skills in this section:

{Provides Oral Hygiene Instruction:386}

Provides Nutritional Counseling Relative to Oral Health

You have selected the following skills out of 5 mandatory skills in this section:

{Provides Nutritional Counseling Relative to Oral Health:387}

Performs Selective Coronal Polishing

You have selected the following skills out of 7 mandatory skills in this section:

{Performs Selective Coronal Polishing:388}

Apply Anti-Cariogenic Agents

You have selected the following skills out of 8 mandatory skills in this section:

{Apply Anti-Cariogenic Agents:389}

Apply Pit and Fissure Sealants

You have selected the following skills out of 7 mandatory skills in this section:

{Apply Pit and Fissure Sealants:390}

Applies Desensitizing Agents

You have selected the following skills out of 6 mandatory skills in this section:

{Applies Desensitizing Agents:391}

Performs Tooth Whitening Using Trays Skills

You have selected the following skills out of 6 mandatory skills in this section:

{Performs Tooth Whitening Using Trays:392}

Below is a summary of your non-refundable NDAEB credential assessment fees. Please review carefully before selecting the "Proceed to Payment" button.