Get Md Continuing Education Requirements Extension Request 2021-2025

This guide provides clear and comprehensive instructions on how to complete the MD Continuing Education Requirements Extension Request form online. Whether you are a dentist or dental hygienist, this step-by-step approach will help ensure a smooth submission process.

Follow the steps to complete the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the designated editor.
2. Identify your role by selecting either the checkbox for 'Dentist' or 'Hygienist.' This ensures the request is processed correctly.
3. Enter your license number in the designated field. Ensure that this information is accurate to avoid processing delays.
4. Fill in your email address, ensuring it is correct, as notifications regarding your request will be sent here.
5. Provide your full name in the appropriate section for proper identification.
6. Enter your address and phone number to maintain updated contact information for future correspondence.
7. In the designated area, state the specific reason why you cannot complete your continuing education requirements by December 31, 2020. Additionally, outline your plan to fulfill these requirements.
8. At the bottom of the form, provide your signature and the date of submission to authenticate your request.
9. Once all sections are filled out, review the information for accuracy and completeness, then submit the form via email or fax as outlined.
10. After submission, keep a copy for your records and await a notification of the outcome via email.

Complete your MD Continuing Education Requirements Extension Request online today and ensure your license remains active.