EFDA Program Application

Purpose Statement

Thank you for your interest in the 2027 Continuing Dental Education Course, "Expanded Functions for the Dental Auxiliary" (EFDA).

Please review the entire application prior to starting in order to understand the required information/documentation. This online form must be completed in one sitting - you cannot save your progress to complete at a later time.

Your employer will need to complete the Employer Assessment & Support Form.

Recommendation letters from current and past employers are preferred and will strengthen the quality of your application.

Deadline: Applications, Employer Assessment & Support, and Recommendation Letters must be submitted on or before September 4, 2026. Late entries will not be accepted.

Applicant Information

First Name:

Last Name:

Middle Name:

Email:

(Email will be our primary method of communicating with you)

Phone Number

Address:

Street:

Include apartment number if applicable.

City:

State:

Zip Code:

Professional Credentials

Certified Dental Assistant

CDA Certification:

DANB

Ohio

AMT RDA

Number of years certified:

CDA proof of registration:

Upload image of current registration card or license that includes expiration date.
One file only.
2 MB limit.
Allowed types: jpg jpeg png pdf.

Registered Dental Hygienist

RDH License:

Ohio

Number of years licensed:

RDH proof of registration:

Upload image of current registration card or license that includes expiration date.
One file only.
2 MB limit.
Allowed types: jpg jpeg png pdf.

Foreign-Trained Dentist

Dental School:

Number of years licensed:

Dental School certificate:

Translated in English
One file only.
2 MB limit.
Allowed types: jpg jpeg png pdf.

Transcripts:

Translated in English
One file only.
2 MB limit.
Allowed types: jpg jpeg png pdf.

Date completed the pre-requisite course “Tooth Anatomy for the Dental Auxiliary”

Date you completed (or the date that you are registered) the pre-requisite course “Tooth Anatomy for the Dental Auxiliary” offered by The Ohio State University College of Dentistry. (Scores are good for 2 years)

Professional Experience:

Total number of years chairside experience, not including time in school: (Required)

Years

Months

*Please list your professional experience for the last 5 years.

Employer:

City and State:

Type of Practice:

Ex. General, Orthodontics, etc.

Position Held:

Job Duties:

Dates Worked

From Date:

To Date:

Employer:

City and State:

Type of Practice:

Ex. General, Orthodontics, etc.

Position Held:

Job Duties:

Dates Worked

From Date:

To Date:

Employer:

City and State:

Type of Practice:

Ex. General, Orthodontics, etc.

Position Held:

Job Duties:

Dates Worked

From Date:

To Date:

Professional Training

In office training only

High School Dental Assisting Program

Graduation Date:

School Name:

City and State:

Post-High School Technical School

Graduation Date:

Number of Years:

School Name:

Degree:

City and State:

College/University

Graduation Date:

Number of Years:

School Name:

City and State:

I attest that the information provided above is true and accurate, and that I have read the “EFDA Continuing Education Course Information Packet” (which can be accessed at go.osu.edu/EFDA)

Attestation

Personal Statement

(Type your statement in the space below, or upload a document.)

Your reasons for seeking admission to this course
Your knowledge of EFDA duties and responsibilities (in Ohio)
Your willingness and ability to spend the necessary time, outside class, to complete required reading and homework assignments of placing amalgam and composite restorations on a typodont.
How you plan to use your EFDA training once you become certified.
Discuss job duties and work experiences that have prepared you for the EFDA curriculum.

Personal Statement upload

One file only.
2 MB limit.
Allowed types: pdf.