Important Forms

Documents Required for Jamaica course:
Please fill up The Form "A" Dental Act with scanned uploaded (JPEG format, max file 20MB)

Photocopy of professional certificate/diploma
Photocopy of current license
Photocopy of front page of passport

FORM "A" DENTAL ACT

* Indicates required field

Applicant Name *

First

Last

Applicant Email *

Applicant Phone Number *

Applicant Work Phone Number *

Applicant Address *

Line 1

Line 2

City

State

Zip Code

Country

Date Of Birth *

Place Of Birth *

Nationality *

Degree or Diploma *

Date Granted *

Institution *

Address *

Postgraduate Qualifications *

Upload a copy of your current license *

Max file size: 20MB

Upload a photocopy of your diploma *

Max file size: 20MB

Upload a photocopy of current passport *

Max file size: 20MB

OTHER COUNTRIES OR INSTITUTIONS, (in which you have practiced, Please enter dates, If None enter NONE *

Has your registration or entitlement to practice as a Dentist ever been cancelled or suspended? ENTER YES OR NO. If you enter YES, for what reason, and on what date? *

Yes No

If you enter YES, for what reason, and on what date? *

Names and addresses (e-mail), phone number's of three (3) character referees*

Name: character referee 1 *

First

Last

Phone Number 1 *

Email 1 *

Name character referee 2 *

First

Last

Phone Number 2 *

Email 2 *

Name character referee 3 *

First

Last

Phone Number 3 *

Email 3 *

To hereby apply to be registered as a Dentist and declare that am the person named in the enclosed diplomas or certificates and that the above information is true and correct, ENTER YOUR NAME TO CONFIRM; I agree to use electronic records and signatures *

Todays Date *

Comment *

Submit