Applications - Lake Norman Dental Assisting School

Dental Assisting I

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Apply online using and submitting the form below. You may also download the application here and send in a hard copy.

Name *

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Last

Address *

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State

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Date of Birth *

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Parent, Guardian, or Spouse Name

Parent, Guardian, or Spouse Home / Cell

High School/College

Year of Grad.

Please Select *

High School Graduate
GED
College

How I heard about this program *

In case of emergency contact:

Name *

Phone *

Relationship *

State, Zip *

Please select which class you would like to attend *

Session I
Session II
Session III
Session IV

I understand that there is a $40.00 nonrefundable application fee to be included as well as documentation of official high school transcript, official GED transcript, or official college transcript, we only need 1 official transcript. Without these two requirements my application will not be complete and sent back. Late fee is $150.00 *

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Dental Radiology Application

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Apply online using and submitting the form below. You may also download the application here and send in a hard copy.

I am a DA II applying for the Challenge Exam

Yes
No

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Applicant's Cell

Employer

Employer Address

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Business Phone

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Date you plan to attend course:

Course Includes:

• 7 hours of instruction in the health, safety, production, and use of dental radiographs
• 7 hours of clinical instruction (taking and developing of radiographs) (14 hours for DA I)
• North Carolina State Board of Dental Examiners approved Dental Radiology exam.
• Certificate of achievement will be awarded to those who attend all 14 hours of instruction and pass the radiology exam. (DA I 21 hours)

We require a $300.00 deposit to hold your place in course

Course hours: 9:00am – 5:00pm with an hour lunch both days.
See our website for specific dates: www.ncdentalassisting.com/course-schedules/

Cancellation, refund, and requirements policy:

A full refund of all monies will be made to any applicant who cancels the enrollment agreement within THREE business days of the first class. All applicants must have at least one year of experience in clinical applications (DA1 will have to attend an additional Saturday clinical) all DA2 and CDA welcome.

Single Line Text

SPICE Application

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Apply online using and submitting the form below. You may also download the application here and send in a hard copy.

Name

First

Last

Address

Address Line 1

City

State

Zip Code

Date of Birth

Email

Home / Cell

Parent, Guardian, or Spouse Name

Parent, Guardian, or Spouse Home / Cell

High School/College Name

Year of Grad.

Please Select

High School Graduate
GED
College

How I heard about this program

In case of emergency contact:

Name

Phone

Relationship

State, Zip

Course Description:

S P I C E is the Statewide Program for Infection Control and Epidemiology

Section 10A NC Administrative code 41A.0206 states: Dental offices shall designate one staff member to direct infection control activities. This person is required to complete a course approved by the state in infection control.

This course is a 5 hour course and fulfills the requirement for sterilization and infection control for DAII status.

Cancellation, refund, and requirements policy:

A full refund of all monies will be made to any applicant who cancels the enrollment agreement within 3 business days of the first class.

Coronal Polishing Registration

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Apply online using and submitting the form below. You may also download the application here and send in a hard copy.

Step 1 of 2

Name *

Birth Date

Address

Address Line 1

City

State

Zip Code

Email *

Phone

Employer

Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Employer Phone

Employer Fax

Date you plan to attend course:

Course Description:

The course is a 7 hour course intended to prepare dental assistants to perform coronal polishing while under the supervision of a licensed dentist.
Instruction includes practice in:

• Aseptic technique 
• Differentiation between stains 
• Clinical appearance of plaque and calculus 
• Abrasive agents 
• Fluoride application 
• Coronal polishing procedure 
• Course Outcomes 

At the end of the course, students take a final written exam and clinical competency exam. In order to pass the course, the student must achieve a 75 percent or higher grade on both exams. Upon successful completion of the course and exams, you will be awarded a Coronal Polishing certificate

The cost of the course is $300.00 with lunch provided.

You will need to pay a deposit of $150.00 to hold your place in the course.

Cancellation, refund, and requirements policy:

A full refund of all monies will be made to any applicant who cancels the enrollment agreement within THREE business days of the first class. All applicants must be classified as DA2 and or CDA.

PAGE EDUCATION AND CONSULTING LLC

Verification of Dental Assistant II Status

The North Carolina State Board of Dental Examiners has ruled that coronal polishing is a legal function for trained Dental Assistant IIs. To be accepted in The Dental Assistant Academy’s Coronal Polishing course, the participant must submit documentation of status as a Dental Assistant II.

Please indicate which training you completed to be classified as a Dental Assistant II. Verify successful completion by attaching documentation or having your employer sign below.

Approved Education and Training Programs

To be classified as a Dental Assistant II, an assistant must meet one of the following criteria:

Successful completion of:

1. An ADA-accredited dental assisting program and current certification in CPR; or
2. One academic year or longer in an ADA-accredited dental hygiene program, and current certification in CPR; or

Successful completion of:

1. Full-time employment and experience as a chair side assistant for two years (3,000 hours) of the preceding five, during which period the assistant may be trained in any dental delivery setting and allowed to perform the functions of a Dental Assistant II under the direct control and supervision of a licensed dentist;
2. A 3-hour course in sterilization and infection control;
3. A 3-hour course in dental office emergencies;
4. Radiology training consistent with G.S 90-29(c)(12) bi-laws of the North Carolina State Board of Dental Examiners; and
5. Current certification in CPR; or Successful completion of the certification examination administered by the Dental Assisting National Board (DANB), and a current certification in CPR. (We can provide a CPR certification if needed)

PARTICIPANT SIGNATURE: I have attached documentation supporting the above classification as a Dental Assistant II.

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Participant’s printed name

AND/OR

Employer Signature: I verify that my employee has completed the above requirements and is classified as a Dental Assistant II.

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Employer’s printed name

Employer Phone Number

CPR Application

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Apply online using and submitting the form below. You may also download the application here and send in a hard copy.

Name *

Address

Address Line 1

City

State

Zip Code

Email *

Phone

Employer

Address

Address Line 1

Address Line 2

City

State

Zip Code

Business Phone

Business Fax

Date you plan to attend course:

Course Description:

C.P.R. (Cardiopulmonary resuscitation) and A.E.D (automated external defibrillation)

Lake Norman Dental Assisting School is a registered training center for The American Safety & Health Institute’s CPR and AED program. This program provides workplace and community training in performing CPR and using an automated external defibrillator (AED)
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The cost of the course is $80.00 community, $40.00 enrolled students.

Cancellation, refund, and requirements policy:

A full refund of all monies will be made to any applicant who cancels the enrollment agreement within THREE business days of the first class.

Application for Dental Front Office

(Download PDF here)

Apply online using and submitting the form below. You may also download the application here and send in a hard copy.

Name

First

Last

Address

Address Line 1

City

State

Zip Code

Date of Birth

Email

Home / Cell

High School/College

Year of Grad.

Please Select

High School Graduate
GED
College

How I heard about this program

In case of emergency contact:

Name

Phone

Relationship

State, Zip

I understand that there is a $40.00 nonrefundable application fee to be included as well as documentation of official high school transcript, official GED transcript, or official college transcript, we only need 1 official transcript. Without these two requirements my application will not be complete

Click and drag to sign

Orthodontic Dental Assisting I

(Download PDF here)

Apply online using and submitting the form below. You may also download the application here and send in a hard copy.

Name

First

Last

Address

Address Line 1

City

State

Zip Code

Date of Birth

Email

Home / Cell

Parent, Guardian, or Spouse Name

Parent, Guardian, or Spouse Home / Cell

High School/College Name

Year of Grad.

Please Select

High School Graduate
GED
College

How I heard about this program

In case of emergency contact:

Name

Phone

Relationship

State, Zip

Please select which class you would like to attend

Session I
Session II
Session III

I understand that there is a $40.00 nonrefundable application fee to be included as well as documentation of official high school transcript, official GED transcript, or official college transcript, we only need 1 official transcript. Without these two requirements my application will not be complete and sent back. Late fee is $150.00

Click and drag to sign

Nitrous Oxide Application

(Download PDF here)

Apply online using and submitting the form below. You may also download the application here and send in a hard copy.

Name *

Birth Date

Address

Address Line 1

City

State

Zip Code

Email *

Applicant's Cell

Employer

Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Business Phone

Business Fax

Date you plan to attend course:

Course Includes:

• This course is designed to provide Dental Auxiliary (DAI, DAII or RDH) with the background knowledge necessary for monitoring nitrous oxide-oxygen analgesia
• Students who complete all 7 hours of instruction will be awarded a certificate of achievement. This certificate allows for the monitoring of patients using nitrous oxide under the direct supervision of a licensed dentist in North Carolina
• Clinical aspect is covered in course with short exam

Approved by the Dental Assisting National Board (DANB) and the NC State Board of Dental Examiners. CE credits: 7.0 hours. Approvals are not endorsements by Governing agencies.

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**The cost of the course is $300.00 with lunch provided. You will need to pay a deposit of $150.00 to hold your place in the course.

Cancellation, refund, and requirements policy:

** A full refund of all monies will be made to any applicant who cancels the enrollment agreement within THREE business days of the first class. All applicants must have at least one year of experience in clinical applications (DA1) all DA2 and CDA welcome.

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Dental Assisting I

In case of emergency contact:

Dental Radiology Application

Course Includes:

Cancellation, refund, and requirements policy:

SPICE Application

In case of emergency contact:

Course Description:

Cancellation, refund, and requirements policy:

Coronal Polishing Registration

Course Description:

The cost of the course is $300.00 with lunch provided.

Cancellation, refund, and requirements policy:

PAGE EDUCATION AND CONSULTING LLC

Verification of Dental Assistant II Status

AND/OR

CPR Application

Course Description:

Cancellation, refund, and requirements policy:

Application for Dental Front Office

In case of emergency contact:

Orthodontic Dental Assisting I

In case of emergency contact:

Nitrous Oxide Application

Course Includes:

Cancellation, refund, and requirements policy:

Lake Norman Dental Assisting School

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Hours