COMMISSION OHIO DENTAL ASSISTANT CERTIFICATION

Instructor Recommendation

I hereby recommend the following student(s) to take the Certified Ohio Dental Assistant exam.

Applicants Name:

NOTE: If more than one student, list all students below. Once notarized copy and attach a copy to each student’s application.

Student(s) are currently enrolled in the second year of a two year Dental Assisting Program

Completion Date:

Student(s) has or will have completed at least 50% of a post-secondary Dental Assisting Program prior to the exam date

Completion Date:

The above named student has maintained above average grades and has demonstrated responsibility, ethical conduct and excellent dental assisting skills in all areas of the dental profession. Student(s) are excellent representative for the dental profession.

Instructor:

Credentials (CDA, CODA, RDH, EFDA):

School:

Address:

City:

State

Zip

Notarized seal/signature:

COMMISSION OHIO DENTAL ASSISTANT CERTIFICATION

Instructor Recommendation

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