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CDE RECORDING FORM
Dental
Assisting National Board, Inc.
676
N. St. Clair, Suite 1880 Chicago, Illinois 60611
(800)
FOR-DANB or (312) 642-3368
FAX:
(312) 642-1475
DANB 's Continuing Dental Education Verification System now requires
certificants to retain proof of their participation in continuing dental
education activities. The Continuing Dental Education Recording Form is
provided to assist you in organizing your documentation.
Instructions:
Make extra copies of this form.� Attach this form to a 9" x 12" envelope or a file
folder. As you complete each continuing dental education (CDE) course, update
this form.
Include
in your envelope or file folder the, following information.
o
Current DANB Recertification Guidelines.
o
Blank, copies of the Recording Form to use
when you complete this one.
o
Documentation for all DANB approved CDE
courses attended. (Read the Guidelines carefully to ensure that credits
you declare are acceptable).
Some
DANB certificants will be randomly selected for certification of their CDE
hours. If you are selected for a DANB audit, you will be asked to submit a
completed Continuing Education Recording Form and copies of documentation
supporting your form entries.� Education
has a two- (2) year lifespan for renewal of certification.
Those
selected for audit will be considered certified during the time they are
providing proof of continuing dental education credit.
Name:
____________________________________CE:
_________________Telephone:______________
I
hereby attest that I have obtained the CDE hours as recorded.��
Signature:
________________________________________Date: _____________________
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