Application Form – Expanded Function Restorative Education Program

Address
Birthday
Are you a registered dental hygienist?
Graduation Date
National board exam you intend to take(Required)
Have you read the requirements of the course and are you able to attend 2 weeks of online lectures prior to the in person start date of 6/14/25?(Required)
Are you able to travel to Spokane, WA and stay for the duration of the course 6/14-6/21?(Required)
This field is for validation purposes and should be left unchanged.