Dental Assisting Program Application

One Year Certificate Program (Full-time)Associate of Applied Science Degree

First Name:*

Middle Name:

Last Name:*

NSHE ID (Student ID Number):*

Email:*

example@example.com

Phone Number:*

Please enter a valid phone number.Format: 000-000-0000.

Date of Birth:*

High School DiplomaHigh School Equivalency (HSE)None

Semester/Year Received:

Name of High School:

YesNo

Name of Institution:

Colleges Attended

List all colleges/universities attended, including Nevada System of Higher Education institutions.

1) School Name:

City/State:

Dates Attended:

Degree:

2) School Name:

City/State:

Dates Attended:

Degree:

YesNo

Attach Unofficial College Transcripts:

High School Proof of Completion

Please attach proof of High School completion or equivalency, such as a diploma, an unofficial high school transcript, or an equivalency certificate.

Note: If you are a high school senior and will not have an official diploma or transcripts until after the application deadline, please submit the unofficial transcripts or a letter on letterhead from a school official indicating you will be completing in June of the current year.

Attach Unofficial High School Transcripts:

Certification and Acknowledgment

I verify that all of the information provided above is true, correct and complete, and understand and read through the application criteria, FAQs and procedures for the Dental Assisting Program at TMCC. I accept complete responsibility for requesting and submitting all required official documents and understand that it is my responsibility to verify receipt of transcripts by TMCC.

Yes, I Agree

Please verify that you are human:*

Sender Name: