This form must be submitted directly by the educational institution(s) you attended. The Office of the Professions will not accept this form if submitted by the applicant.
- Section I: Complete this section before sending the entire form to your school. Be sure to sign and date item 9.
- Section II: The Registrar must complete this section and return both pages of the form in an official school envelope with requested documents directly to the Office of the Professions at the address at the end of the form.
A transcript of all courses taken at the dental school and grades received must be attached for all graduates of non-registered or non-accredited programs. Additionally, the school must attach a transcript of all courses convalidated or accepted for transfer credit and the basis on which these subjects were convalidated, including the name of the institution from which credit was transferred. When studies were completed at more than one school, official records need to be sent to the Department from each school. Please photocopy the form as needed.
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