6-Month EFDA Online Application

EFDA Online Education

Dental Assisting Academy of the Palm Beaches 6-Month Online Dental Assisting Education. Following completion of the Online Course you will receive your Educational Certification.
Student Name*

First NameLast Name
Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date*

MonthDayYear
Mobile Number*
Format: (000) 000-0000.
FemaleMaleOther
Student E-mail*
FacebookInstagramGoogleReferralOther
** Please be Advised **

Allow for up to 2-Weeks prepration time BEFORE the start date of class.
Courses*
January 14thFebruary 3rdMarch 3rdOther
Online E-BookPhysical Hard BookNo Book, I'll just use my online course & powerpoints!
Please upload a copy of your Drivers License, Passport, or other issued Government ID *

Browse Files
Just the photo side (front side) is needed. Cancelof
Additional Comments
Online Tier One Includes: 6-Month Online Education Program & Book Access

Online Tier Two Includes: 6-Month Online Education Program, Dental Lab Kit & Book Access

Online Tier Three Includes: 6-Month Online Education Program, Dental Lab Kit, Book Access & 1-Day EFDA/Radiology Course (Tier 3 Students MUST be able to attend 1-Day Class in West Palm Beach, FL after 200 Clinical Training Hours are completed)

Enrollment Deposit: If you would like to see interest free payment plan options for the Tier option you choose you can place the inital payment of the Enrollment Deposit. This payment will go towards your Tier selection and payment plan.
Online Tier OneOnline Tier TwoOnline Tier Three
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EFDA Online Education