ALD Standard Level Certification Training Part 2

Application for ALD Standard Level Certification Training Part 2

Please review this form in its entirety before completing it.
INSTRUCTIONS

Please familiarize yourself with the requirements for ALD Standard Level Certification Part 2 Training Course submissions document prior to completing this form. It will take approximately 45 minutes to complete. We recommend that you print it to peruse prior to completing the necessary information. This will allow you time to gather the answers prior to submission. This is a formal application and review process.

ELIGIBILITY

Individuals who are approved Speakers Bureau presenters can apply to present the ALD Standard Certification course.

ABOUT PART 2

This program includes 6 hours of didactic device-specific or wavelength(s)-specific training, with more than 3 of which are devoted to supervised hands-on activities which include a comprehensive clinical simulation examination. Also included is a 1-hour review of Foundations in Laser Dentistry Part 1 digital course key concepts and a course evaluation. This program presumes adequate availability of qualified instructors and lasers with no more than a 1:15 instructor-to-student ratio and 1:5 laser-to-student ratio.

Please note that fields with * indicate a required field.

QUESTIONS

If you have any questions contact Fern Carbonell by email academyoflaserdentistry@gmail.com or call the ALD office 954-346-3776.
1. Name *

First Name Last Name
2. Email *
example@example.com
3. Primary Phone *

Area Code Phone Number
4. Provide a 150-word narrative of why you are qualified to certify applicants. *

0/200
5. Please select an answer. *

I have presented an ALD recognized certification course in the past 36 months. This would be my first time teaching an ALD recognized certification course .
6. If you have presented in the past 36 months, please provide a sample of your certification course materials

Browse Files
Provide a Word or PDF file. Cancel of
7. Provide a statement of evidence that you can acquire an adequate physical plant (room, location, electrical and safety needs) with the required audio visual setup. *
8. Provide sources of lasers and equipment including safety equipment and disposable supplies like gowns, masks, and gloves. *
9. Provide a training day schedule of activities that contain the appropriate didactic and hands-on content appropriate for the wavelengths that will be certified. *

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Accepted formats are: PDF, DOC, DOCX Cancel of
10. Provide your slide deck in PDF format (2 slides to a page is preferred) that will be used for the training day course. *

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Please provide file in PDF format only. If you need assistance converting the file, please send email to academyoflaserdentistry@gmail.com Cancel of
11. As an approved ALD trainer, I understand the following criteria (please check each box): *

I will adhere to the 1:15 instructor-to-participant ratio and 1:5 laser-to-participant ratio requirements. When additional faculty is needed, I will adhere to the Criteria for Additional Standard Training Course Faculty. If the course is intended for dental hygiene, then the course content and faculty will reflect that. If the course is intended for a laser safety officer training certificate, then the course content and faculty will reflect that. The recommended Specimen Protocol will be followed. The Laser Safety Protocols will be followed. The Proctored Clinical Simulation Examination will be administered and recorded. An ALD Course Evaluation will be provided to attendees to complete.
Thank you for your submission to be considered as a speaker/trainer for the ALD Standard Level Certification Training Part 2. Your application will be reviewed by the committee and you will be notified by email as to the results within 30 days of your submission date.

Please click the submit button below to complete the application.

You will receive a copy of your responses to the email address you provided. Please check your spam folder if you do not see it in your email.
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Application for ALD Standard Level Certification Training Part 2