Other Information

Select your first language (the language of your birth). If you speak additional languages, click Add Another Language. Then, select the language(s) and the level of your proficiency in each.

If you have US military experience, select your anticipated status at the time of enrollment from the drop-down. Select Not a member of the military if this does not apply.

If a member of the military, select your branch of the Armed Forces from the drop-down and indicate the dates of service.

Enter your DENTPIN. This is a unique identification number that is assigned by the American Dental Association. Visit the American Dental Association site for more information or to obtain a DENTPIN.

Indicate whether you have ever been disciplined or placed on academic probation while attending an academic institution. If you select Yes, enter a brief explanation in the field provided. Include:

1. A brief description of the incident
2. Specific charge made
3. Related dates
4. Consequence
5. A reflection on the incident and how the incident has impacted your life.

Indicate whether you have ever had any certification, registration, license, or clinical privileges revoked, suspended, or in any way restricted by an institution, state, or locality. If yes, enter an explanation in the spaces provided.

Note that once you submit your application, you can update License Infractions only if you submitted your application with an answer of No.