Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor of your choice.
2. Begin by entering your name in the designated field for 'Applicant’s Name.' Ensure that your name is spelled correctly for verification purposes.
3. Next, provide the name of the dentist in the 'Dentist’s Name' field. This should reflect the supervising dentist at the dental office where you gained your experience.
4. Fill in the 'Office Address' section with accurate details, including the street address, city, state, and zip code of the dental practice.
5. In the 'Office Telephone' field, enter the office's area code and telephone number. This information is important for potential verification.
6. Provide the office email address in the designated field for the 'Office E-mail Address.' This should be an official email for communication purposes.
7. Identify your position title at the dental office in the 'Applicant’s Position Title' field. This should clearly state your role during your work experience.
8. Indicate the dates of your service by filling out both the start and end dates in the 'Dates of Service' section using the correct month/year format.
9. Specify whether you were working full-time or part-time by selecting the appropriate option and, if part-time, enter the number of hours worked per week.
10. Ensure to have the supervising dentist sign the form in the 'Dentist’s Signature' section, and obtain the official office stamp as it is a requirement for validation.
11. Finally, check all entries for accuracy, save your changes, and choose whether to download, print, or share the completed form as needed.

Complete your forms online efficiently by following these steps for accurate submissions.