- This form must be submitted directly to the Office of the Professions by the director of an advanced education program in general dentistry or in a dental specialty, provided such program is accredited by an organization accepted by the Department. 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 the program director of the advanced education program you completed. Be sure to sign and date item 6.
- Section II: The program director of the advanced education program you completed must complete this section and return both pages of the form directly to the Office of the Professions at the address located at the bottom of the form.