Get Out Of State Certification Form - Dental Board Of California - Dbc Ca

Filling out the Out Of State Certification Form is an essential step for applicants seeking certification from the Dental Board of California. This guide will walk you through the process, ensuring you complete each section accurately and efficiently.

Follow the steps to successfully complete the Out Of State Certification Form.

1. Click ‘Get Form’ button to acquire the form and open it for editing.
2. Begin by completing the top portion of the form. Provide your name in the designated fields for last name, first name, and middle name. Ensure all entries are accurately filled.
3. Fill in your current address details. Include your city, state, and zip code for proper identification.
4. Enter your date of birth in the required MM/DD/YYYY format. Make sure the information is clear and correct.
5. Indicate your sex by selecting the appropriate option of 'Female' or 'Male.' This section is important for your certification records.
6. The next section is to be filled out by the licensing agency. Ensure they complete the certification details, including your name, dental school attended, graduation date, license number, state or country of issuance, and the expiration date of the license.
7. The licensing agency must also confirm that your license is in good standing and that no disciplinary actions are pending or have been taken. This section requires a signature from the agency official.
8. After all required fields are completed, review the entire form for accuracy. If any modifications are made to the certification, attach a written explanation as specified.
9. Once you have verified all information is correct, save the changes, then you can download, print, or share the completed form as needed.

Complete the Out Of State Certification Form online today for a smooth application process.