Certificate in Dental Radiography Application Form Original

PERSONAL INFORMATION

Your personal information is required in order that we can properly assess your suitability for this course. Your personal data is very important to us and we will only share it with the course applicant assessors. We will take all technical and organisational measures necessary to protect your personal data in accordance with the General Data Protection Regulation, 2018 and the Data Protection Act, 2018. Your data will be retained in accordance with our data retention & destruction policy.

EMPLOYER DETAILS

ACCESS TO EQUIPMENT

Please ask your employer to assist you in completing this important section.

DENTAL NURSING / DENTAL HYGIENE EDUCATION

Please provide details of your dental nursing and / or dental hygiene qualification, including:
  1. Name of the programme
  2. Award received
  3. Date of qualification

IN ORDER TO COMPLETE THIS APPLICATION YOU MUST UPLOAD A COPY OF THE ABOVE QUALIFICATION(S) VIA THIS ONLINE APPLICATION FORM.

ADDITIONAL INFORMATION

DECLARATION

It is important that page 2 of the Supporting Documentation (this is available at the end of the programme information page – see the 'Applications' area) is completed and submitted below.

Please scan and UPLOAD each document below. Paper applications will not be accepted.

Tick each box below to confirm:

  • Proof of non-infection with Hepatitis B. This must be dated within 6 months.
  • Proof of non-infection with Hepatitis C. This must be dated within 6 months.
  • Proof of Hepatitis B immunity. The result must be greater than 10mIU/mL

Please wait until you are requested to send the blood test results. These will be sent confidentially and directly to the Dental Nurse Tutor and not via this on-line process.