Dental Hygiene Program - Documentation of Chairside Dental Assistiting Experience - nvcc 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name in the 'Applicant’s Name' field. Ensure that this matches your official documents.
3. Fill in the 'Dentist’s Name' and 'Office Address' sections accurately, including street address, city, state, and zip code.
4. Provide the office telephone number, ensuring you include the area code for proper contact.
5. Input the office email address where correspondence can be directed.
6. Indicate your position title within the dental office and specify the dates of service using the Month/Year format.
7. Select whether you were a full-time or part-time employee. If part-time, indicate your hours per week.
8. Ensure that all information is accurate before obtaining the dentist's signature and official office stamp on the form.
9. Finally, confirm that all signatures are dated between January 15th, 2016 and February 15th, 2016 to meet submission requirements.

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