GDEI Pre-Application 2026

1
Student Name* This field is required.
First Name
Last Name
2
Email Address* This field is required.
example@example.com
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3
Phone Number* This field is required.
Please enter a valid phone number.
4
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
County of Residence* This field is required.
Huge
Large
Normal
Small
Ok
Ok
6
Date of Birth* This field is required.
Date
Month
Day
Year
7
GDEI Location of Interest
Please Select
Please Select
GDEI Albany Campus (Southwest Georgia Location)
GDEI Moultrie Campus (Southwest Georgia Location)
GDEI Riverdale Campus (South Atlanta Location)
GDEI Virtual Campus
8
GDEI COURSES OF INTERESTYou can select more than one.
Dental Assistant Program
Dental Radiology Program (Included in Dental Assistant Program)
Dental Orthodontic Assistant Program ( Must have completed Dental Assistant Program)
Dental CPR
Dental Hygiene Anesthesiology Certification
Dental Prophylaxis Certification ( Must have completed Dental Assistant Program)
Expanded Functions Dental Assistant Program ( Must have completed Dental Assistant Program)
9
What is the status of your High School Diploma?
Graduated: I have a Highschool Diploma.
In Process: Graduating soon with GED/HS Diploma
GED
I am no longer in school for HS Diploma/GED
10
Copy of Driver's LicensePlease take a picture of your drivers license ID.
11
Copy of High School Diploma/GEDPlease take a picture of your highschool diploma or GED.
12
Upload Driver's License
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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13
Upload High school Diploma/GED
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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14
Have you ever attended college or post-secondary education?* This field is required.
Please Select
Please Select
Yes
No
Currently enrolled
15
If yes, what was the last college you attended?* This field is required.
16
Have you ever taken any dental assistant courses or completed a dental assistant program before?* This field is required.
Please Select
Please Select
Yes
No
17
If yes, please briefly describe the course or program you completed:
18
Why are you interested in becoming a dental assistant?* This field is required.
19
Are you currently employed?* This field is required.
YESNO
20
What do you hope to gain from this program?* This field is required.
21
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