Clone of Program Inquiry Form

CLEVELAND DENTAL ASSISTING SCHOOL

103 S. Roosevelt Ave, Cleveland, TX, 77327

(936)-539-4882
PROGRAM INQUIRY Form

1/26-4/26
Name*

First NameMiddle InitialLast Name
Date of Birth
Phone*
E-mail Address*
example@example.com
Are you interested in starting our next class?

MonthDayYear
Next Class starts January 2026
Do you have a GED or High School Diploma

YESNOOther
Do you have a Texas Driver's License or ID

YESNO
Do you have a Social Security Card ?

YESNO
Dear Prospective Students,

We are excited to announce that registration is now open for our upcoming Dental Assistant Program, beginning on January, 2026. This is a fast-track 12-week program with additional online coursework during the week. Classes will be held on Saturdays only, so please be prepared to arrange transportation to and from the program.

Important Information:

Program Cost: $3,500.00, plus an additional $250.00 for documents required to process your Dental Assistant license upon completion of the course.

Payment Options: We offer a payment plan, payments are due 5th and 20th of each month.

Required Documents to Register:

Texas Driver’s License or Texas ID
Copy of High School Diploma
Social Security Card

* Clear Background Check *

Seats are limited and will be filled on a first-come, first-served basis. To secure your spot, you must submit all the required documents. Additionally, a $250.00 deposit is required to reserve your seat. Once your deposit is received, you will be directed to complete the registration form.

Deposit:

Please note that the deposit is not required but is only used to secure your seat in the next class. We accept only 9 students per class, so securing your spot early is highly recommended.

If you have any questions, feel free to reach out. We look forward to seeing you in class!
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PROGRAM INQUIRY Form