FORMS

12 Week Dental Assistant Program - Externship Information

What forms do I need for my Externship interview to show/give the eXternship site?

Please read the following Externship Information Page – Print

Before Starting an Externship each Student  must sign a “Consent to Begin Externship” Form 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 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 12 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 it to the Academy for Dental Assistants,  prior to starting an Externship and/or prior to the last day of class. Please be sure you thoroughly read the “Consent to Begin Externship” before starting your Externship and before the completion of the 12-Week Program. 

  • 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” 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 12 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.

Return the following 2 forms SIGNED by Dentist back to us AFTER your 200 Hours

After your Internship is Completed have the dentist sign the following forms and return them to our office

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 THIS FORM TO TALLAHASSEE UNTIL AFTER YOU HAVE TURNED INTO OUR OFFICE AND YOU RECEIVE YOUR EFDA AND X-RAY CERTIFICATIONS FROM US

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.

AFTER YOU RECEIVE YOUR CERTIFICATIONS FROM US

Dental X-ray Certification Application

Print this form and follow the directions on the top of the page to apply for your Radiology License AFTER you take the Dental X-ray Certification Course.
Select the Blue Button Below to Print a Copy of the Radiology Application.

Dental Radiology Application Information

Dental Radiology Application Information

After you receive your Dental Radiology Certification, Please follow the Directions that are on the top of the Application Form (and listed below) Be sure to send all 4 pages and be sure the dates are no less than 3 months with the dentists signature and license number on page 1 and page 2-4 is your personal information and your signature.  The directions are on page 1 of the application at the top of the page as follows:

SPECIAL NOTES AND INSTRUCTIONS:

1. A NON-REFUNDABLE fee of $35.00 is required at application. Please make check or money order payable to the Board of Dentistry and mail to the Department of Health, P. O. Box 6330, Tallahassee, FL 32314-6330.
If you need to send additional information that does not include a check or money order, mail it to Department of Health, Board of Dentistry, 4052 Bald Cypress Way, #C08, Tallahassee, FL 32399- 3258.

2. Certification requires three (3) months continuous experience assisting in the exposing of radiographs under the DIRECT SUPERVISION of a Florida licensed dentist and successful completion of a Board of Dentistry approved course. The approved course must have been completed within 12 months after the on-the-job training. Attach a copy of the certificate you received from the approved course you attended.

 Please Note: You only send a COPY of your Radiology Certificate along with the 4 page application and $35 to the BOARD OF DENTISTRY – NOT TO US.

 You can only do this AFTER you take the Course and receive your Dental Radiology Certification that we give you.

 EFDA Certification

You DO NOT send in your EFDA Certification only a copy of the Radiology Certification and Application and you will receive a Radiology License back from the Board of Dentistry.

You do nothing further with your EFDA Certification. It does not have to be sent to the Board of Dentistry ONLY the Radiology Certification.

Your X-ray and EFDA Certifications Never Expire, do not need Renewing and Florida does not currently require any Continuing Education for a Dental Assistant.

If you need any further help please feel free to contact us at info @academy4da.com or 727.914.0599. Or you can contact the Board of Dentistry Directly at 850.245.4474

1 Day Dental X-ray/EFDA/Combo Course

Print this form and have it signed by a dentist as proof of training for the EFDA and/or Dental Radiology Certification Course. Email or fax it to our office PRIOR to Part 2 of your Course. (Not required for the 12 week course or Orthodontic Course)

Dental X-ray Certification Application

After you complete the Dental Radiology Certification Course and Receive your Certificate

Dental Radiology Application Information

Dental Radiology Application Information

After you receive your Dental Radiology Certification, Please follow the Directions that are on the top of the Application Form (and listed below) Be sure to send all 4 pages and be sure the dates are no less than 3 months with the dentists signature and license number on page 1 and page 2-4 is your personal information and your signature.  The directions are on page 1 of the application at the top of the page as follows:

SPECIAL NOTES AND INSTRUCTIONS:

1. A NON-REFUNDABLE fee of $35.00 is required at application. Please make check or money order payable to the Board of Dentistry and mail to the Department of Health, P. O. Box 6330, Tallahassee, FL 32314-6330.
If you need to send additional information that does not include a check or money order, mail it to Department of Health, Board of Dentistry, 4052 Bald Cypress Way, #C08, Tallahassee, FL 32399- 3258.

2. Certification requires three (3) months continuous experience assisting in the exposing of radiographs under the DIRECT SUPERVISION of a Florida licensed dentist and successful completion of a Board of Dentistry approved course. The approved course must have been completed within 12 months after the on-the-job training. Attach a copy of the certificate you received from the approved course you attended.

 Please Note: You only send a COPY of your Radiology Certificate along with the 4 page application and $35 to the BOARD OF DENTISTRY – NOT TO US.

 You can only do this AFTER you take the Course and receive your Dental Radiology Certification that we give you.

 EFDA Certification

You DO NOT send in your EFDA Certification only a copy of the Radiology Certification and Application and you will receive a Radiology License back from the Board of Dentistry.

You do nothing further with your EFDA Certification. It does not have to be sent to the Board of Dentistry ONLY the Radiology Certification.

Your X-ray and EFDA Certifications Never Expire, do not need Renewing and Florida does not currently require any Continuing Education for a Dental Assistant.

If you need any further help please feel free to contact us at info @academy4da.com or 727.914.0599. Or you can contact the Board of Dentistry Directly at 850.245.4474

Print this form and follow the directions on the top of the page to apply for your Radiology License AFTER you take the Dental X-ray Certification Course.

Select the Blue Button Below to Print a Copy of the Radiology Application.

Expanded Functions Dental Assistant and Dental X-ray Certification Course

Phone: 727-914-0599  /  Fax:  727-279-4631  / Email:  info@academy4da.com

 

 

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