Recertification Form - Commission on Ohio Dental Assistant - codacertification 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name and CODA Certification number in the designated fields. Ensure accuracy as this information is crucial for your recertification.
3. Fill in your email address, mailing address, city, and zip code. If you have a new address, check the box provided.
4. Provide your phone number and the last four digits of your Social Security number for identification purposes.
5. Document your Continuing Education Hours by listing each course title, date, sponsor, speaker, and total hours completed. Remember that a minimum of 12 hours is required annually.
6. Calculate your fees based on the postmark date. If submitted by December 31, include a fee of $20; otherwise, include a late fee for a total of $30.
7. Sign and date the form at the bottom before submitting it to ensure it is valid.

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