School Of Dental Assisting
Seal Of Approval

Contact NSDA Vancouver:
19301 SE 34th Street
Camas, WA 98607

Telephone Numbers:
360-844-5391 office
360-882-3322 fax







Upcoming Classes


• Sunday January 29, 2012

• Sunday, April 29, 2012

• Sunday, July 29, 2012

Oregon Radiation Protection Services certified course in radiology will be offered soon.

Application For Enrollment


If you would like to download this application as a PDF to review and send in by mail click here. You will need Adobe Acrobat reader to view this form.


APPLICATIONS ARE ACCEPTED THROUGHOUT THE YEAR FOR ALL SESSIONS
Denotes required fields

First Name Last Name
Street Address
City State Zip
Home Phone Mobile Phone

Email Date of Birth

Ever been convicted of a drug related offense? Yes No
In case of emergency, whom should we contact?
Relation and Phone Number


EDUCATIONAL DATA

Highest Grade Completed College Graduate Degree Yes No
High School Diploma or G.E.D.? Yes No Completion Date


EXPERIENCE

Please state briefly why you wish to attend dental assisting school:
Please describe any dental office experience you have had up to now:


Session applying for
Need a Catalog Yes No
I certify that all the information provided is complete and accurate to the best of my knowledge.
Yes No
How did you hear about us? If Other:
Additional Comments:




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