FORMS

Please read the following Externship Information Page – Print

Before Starting an Externship each Student  must sign a “Consent to Begin Externship” Form Due Module 19, Stating that you have completed all the Requirements to begin your Externship. This can be found in the Handouts Section or in the next tab. Print, Sign and give to your Instructor or email to our Front Office at info@academy4da.com. PLEASE NOTE: It is VERY IMPORTANT that you understand the Consent to Begin Externship. If you have any questions or concerns please contact the Business office or ask your Instructor.

It is the students responsibility to secure an Externship site. When seeking an Externship you should provide the dental office with:

1. Your Resume

1a. Cover letter if mailing or dropping off at office or cover letter info in the body of the email if emailing with attachments. (see sample )

2. Letter to Dental Office from School regarding Externship

3. Copy of Professional Liability Insurance

4. EFDA – 200 Hour Externship Form  – ( send this form back to us AFTER Externship is completed)

5. X-ray Externship Form (Page 1 ONLY of Radiology Certification Application –  send this form back to us AFTER Externship is completed)

 IMPORTANT: DO NOT SEND THIS FORM TO TALLAHASSEE UNTIL AFTER YOU HAVE TURNED INTO OUR OFFICE AND YOU RECEIVE YOUR EFDA AND X-RAY CERTIFICATIONS FROM US

Securing an Externship is much like interviewing for a job. You will call, email or go to a dental office, explain that you are in a dental assisting program that requires a 200 hour/3 month Externship for Certification and provide the office with the above listed forms.

The days and times for your Externship is determined between you and the Dental Office depending on your availability and the needs of the office.

Please remember that your Externship cannot be completed any quicker than 3 months, approximately 16.5 hours per week to finish in 3 months. You have up to 6 months to complete your Externship. It is your responsibility to keep track of your hours.

Please Note: Although it is an “Externship” you must go to the office as scheduled between you and the dental office. It is not advised to call out sick or not show up to your Externship site if you are scheduled to on a specific day. The dental office may schedule patients based on you being there to help and if you call out or do not show up it is a hardship on the office. Your Externship site has to ability to terminate your Externship for excessive absences or if they feel it is not working out.

You will use the “Hours Log” to keep track of your hours and have a supervisor initial your hours daily.

PLEASE NOTE: Your Externship MUST be started no later than 1 month after the completion of the 12 week Course.

Once you have completed the 3 months/200 hours, the dentist must sign 2 forms the Dental X-ray Form (page 1 only) and the EFDA – 200 Hour Externship Form. You will mail, email or drop off those 2 completed Forms to Academy for Dental Assistants and we will issue your 2 Florida Board of Dentistry Certifications: Dental X-ray Certification and Expanded Functions Dental Assistant Certification.

Email: info@academy4da.com

Fax 727-279-4631

Prior to starting an Externship and prior to the last day of the 12 Week Program, all students must sign a “Consent to Begin Externship” (below) and return to your instructors by Module 19,  prior to starting an Externship.

Please be sure you thoroughly read the “Consent to Begin Externship” before starting your Externship and before the completion of the 12-Week Program. 

on the “Consent to Begin Externship” an Externship Site must be “Secured” – set up, with a start date scheduled and all the Externship Site Information listed on the “Consent to Begin Externship” and submit to the instructors by Module 19 or they will not receive their “Certificate of Completion” for the 12 Week Program on the last day of class.

• The Consent acknowledges that the student has completed the OSHA  and Preventing Needle Stick Injury Training (Section 3), they are aware of the requirements to begin an Externship, forms needed to provide an Externship Site before beginning , forms required to return to the School after completing the Externship, what type of Dental Office they can complete an Externship, their responsibilities at an Externship, the requirement of when they must begin their Externship, the consequence if they do not begin their Externship in the required time frame, and how long they have to complete the Externship.

IMPORTANT INFORMATION

Externships can begin after Section 2 of the Course is completed and NO LATER than 1 month after the last day of the course. If the student has not started their Externship before 1 Month AFTER the last day of class, they will be required to take a 1-day Remediation Clinical Hands-On course at the cost of $150 in order to Refresh their Dental Assisting Skills before they can begin their Externship and must inform Academy for Dental Assistants of the Externship Site Name, Location and Contact information.

If the student does not want to start their Externship during the 12 Week Program and wants to wait until after the completion of the 12 Week Program, they have 1 month from the last day of class to start their Externship, BUT by the last day of the 12 Week Program the student must at least have an  Externship Site “Secured” – set up, a start date scheduled and all the Externship Site Information listed on the “Consent to Begin Externship” and submit to the instructors by Module 19 or they will not receive their “Certificate of Completion” for the 12 Week Program on the last day of class.

Just like the saying “if you don’t use it, you lose it”.  This has happened many times in the past with students that did NOT start their Externship either during class or immediately after the 12 Week Program ended. Once they did begin their Externship, they had forgotten some or most of the procedures they were taught in class and the Externship Site called the Director to state the student as not ready for their Externship and the Externship site could not use them.

• The Student has 6 Months to complete their Externship from the last day of the Course.
• Externships can only be done at a Florida General Dentist Office and not at any Specialty Dental Offices (and not even a Pediatric Office).

Page 1 only gets signed and given to the dentist and returned to us. Pages 2-4 are for your personal information once you send in all 4 pages to the Board of Dentistry AFTER you receive your Certifications from us at the end of your Externship.

Provide your Externship site with a copy of the Professional Liability Insurance you Obtained when you Registered for the Class Initially.

1. EFDA – 200 Hour Externship Form  – (send this form back to us AFTER externship is completed)

2. X-ray Externship Form (Page 1 ONLY of Radiology Certification Application –  send this form back to us AFTER externship is completed)

2b. IMPORTANT: DO NOT SEND IN THE 4 PAGE RADIOLOGY APPLICATION FORM TO TALLAHASSEE UNTIL AFTER YOU HAVE TURNED INTO OUR OFFICE AND YOU RECEIVE YOUR EFDA AND X-RAY CERTIFICATIONS FROM US. We will provide more direction on this step once you turn in your completed externship forms to us.

All the Externship Forms you need are in the HANDOUTS SECTION online in the 12 Week Course.

Email: info@academy4da.com
Fax 727-279-4631

Page 1 only gets signed and given to the dentist and returned to us. Pages 2-4 are for your personal information once you send in all 4 pages to the Board of Dentistry AFTER you receive your Certifications from us at the end of your Externship.