Get Application Form - State Of Oregon - Oregon

This guide provides a clear and comprehensive overview of the Application Form for Licensure with the Oregon Board of Dentistry. Here, you will find step-by-step instructions to assist you in correctly filling out the application online.

Follow the steps to successfully complete your application form.

1. Click ‘Get Form’ button to open the application form in your preferred editor.
2. Begin by filling out your personal information, including your first name, middle name, and last name. If you have used any other names, please include them in the designated field.
3. Provide your contact details, including your telephone number and mailing address, ensuring that you complete the city, state, and ZIP code fields accurately.
4. Enter your date of birth, place of birth, and social security number. Make sure your information is accurate as this will be used for verification purposes.
5. Detail your college education and any dental/dental hygiene schools you have attended, including the names, locations, dates of attendance, and degrees obtained.
6. If applicable, mention any specialty training or board memberships, along with the corresponding training details.
7. Respond to the questions regarding your professional history, particularly concerning any disciplinary actions or conditions that could affect your ability to practice safely. If you answer 'yes' to any of these questions, detail your responses on a separate sheet.
8. Insert your recent passport-sized photograph in the indicated area, signing and dating it across the bottom.
9. List all states where you are or have been licensed to practice, along with the type of licenses and their statuses.
10. Complete the employment history section, detailing all positions held in dentistry or dental hygiene, along with any formal training.
11. In the affidavit section, provide your legal signature and type your name as it appears in the application.
12. Finally, ensure that you have attached any necessary documents and fees. When complete, you can save changes, download, print, or share your application.

Complete your application online today and take the next step towards licensure.