Online Registration

Complete the form below to begin your enrollment. A school representative will follow up to finalize your paperwork.

Student Information

Last Name *

First Name *

Street Address *

Apt./Unit No.

City *

State *

Zip *

Cell Phone *

Home/Alternate Phone

Email *

SSN (optional — may provide in person)

Birth Date *

Desired Start Date of Class *

Education & Background

Proof of Education *

Graduation / GED Date *

You will be required to bring a copy of your diploma or GED certificate when you visit in person.

College(s) Attended

Date(s)

Have you ever been convicted of any felony or drug-related misdemeanor? *

NoYes

Criminal History Notice: Certain criminal convictions may delay or prevent Registered Dental Assistant (RDA) registration through the Texas State Board of Dental Examiners. Contact the TSBDE with questions before enrolling.

Emergency Contact Information

Full Name *

Relationship *

Primary Phone *

Alternate Phone

Payment Option

Select your preferred payment plan. Final payment details will be confirmed in person.

Option 1: $3,500

Pay in full prior to class beginning. No deposit, no auto-payments.

Option 2: $3,600

$1,200 deposit + 12 weekly auto-payments of $200. Includes $50 payment plan fee.

Option 3: $3,700

$700 deposit + 12 weekly auto-payments of $250. Includes $100 payment plan fee.

Preferred Method of Payment *

Enrollment closes the Monday prior to the first day of class. No interest charged on payment plans.

Acknowledgements

I understand I will need to review and sign the full Enrollment Agreement and Cancellation & Refund Policy in person before enrollment is finalized.I acknowledge that I will receive a copy of the DFW Dental Assisting School Student Handbook which includes Policies and Procedures for: Grievances, Conduct, Attendance, Make-up Work, Withdrawal, and Privacy.I understand that completion of this program does not guarantee RDA registration. Graduates must independently apply to the Texas State Board of Dental Examiners and meet all requirements including background check, Jurisprudence Assessment, CPR/BLS, Human Trafficking Prevention Training, and radiology certification.

Licensing Disclosure

This program prepares students to apply for Registered Dental Assistant (RDA) registration through the Texas State Board of Dental Examiners (TSBDE). Completion of this program does not guarantee licensure, registration, or employment.

Approved and Regulated by the Texas Workforce Commission, Career Schools and Colleges, Austin, Texas.

By submitting this form you agree to be contacted by DFW Dental Assisting School regarding your enrollment.