6-Month EFDA Online Application

EFDA Online Education

Dental Assisting Academy of the Palm Beaches 6-Month Online EFDA Education. Following completion of the Online Course you will receive your Educational Certification. Classes must be paid in full before beginning in the course, you may place a $100 non-refundable deposit if you know you would like to start but would like to talk to someone with more information regarding class tier choices.
Student Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Birth Date *

Month Day Year
Mobile Number *

Area Code Phone Number
Gender *

Female Male
Student E-mail *
How did you hear about Dental Assisting Academy of the Palm Beaches? *

Facebook Instagram Google Referral
** Please be Advised **

Allow for up to 2-Weeks prepration time BEFORE the start date of class.
Courses *
Start Date of Course *

June 7th July 5th August 2nd September 6th
Textbook Type Request *

Online E-Book Physical Hard Book No 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. Cancel of
Additional Comments
Non-Refundable Deposit: Discuss Tier Options before commitment!

Online Tier One Includes: 6-Month Online Education Program

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

Online Tier Three Includes: 6-Month Online Education Program, Dental Lab Kit & 3 Practice CDA Exams

Online Tier Four Includes: 6-Month Online Education Program, Dental Lab Kit 3 Practice CDA Exams, & 1-Day EFDA/Radiology Course (Tier 4 Students MUST be able to attend 1-Day Class in West Palm Beach, FL after 140 Clinical Training Hours are completed)
Class Tier Selection: *

Online Tier One Online Tier Two Online Tier Three Online Tier Four
Class Payment Selection *
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Deposit $ 100.00

Online Tier One $ 590.00

Online Tier Two $ 690.00

Online Tier Three $ 790.00

Online Tier Four $ 1,405.00

Total $ 0.00
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EFDA Online Education