6-Week Website Application

Student Application

Dental Assisting Academy of the Palm Beaches
NOTICE: The 6-Week Dental Receptionist & Insurance Program is currently on pause until further notice. We are updating the curriculum to best teach you!

If you submit an application for a future program, we will contact you once the program is available. NO Program is available at this time.
Full Name of Student

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Date of Birth

MonthDayYear
Name of Emergency Contact

First NameLast Name
Emergency Contact Phone #

Area CodePhone Number
What month would you like to begin in the 6-Week Receptionist & Insurance Program?

Other
I understand that the 6-Week Receptionist & Insurance program is currently UNAVAILABLE.
All On-Campus Training Sessions are held on Thursdays ONLY from 10am - 3pm!

Dental Assisting Academy of the Palm Beaches Assessment

Please answer the following questions to complete the DAAPB Assessment. Did you know: 99% of our students get accepted, 98% graduate and 97% find their dental dream careers & homes!
Why do you want to be a member of the Dental Healthcare Team?
What do you already know about the job as a dental receptionist?
What do you hope to gain & accomplish by becoming a dental receptionist?
What qualities & traits do you have that you think will make you an asset in the dental field?
Will you be able to manage your time with your current schedule and the course?
What do you think is a good starting hourly pay for a dental receptionist?
What does the ideal dental receptionist look like to you?
What is your Instagram Name?! We would love to follow you!
What is your current employment?
What shifts at work do you take?
Are you fluent in any other languages? Please select all that apply
How did you hear about Dental Assisting Academy? If you were referred to us, please let us know by who!
Do you have a minimum of a High School Diploma or GED? *International Degrees are accepted
Please Note: Students who DO NOT have a High School Diploma or GED are subject to take an Entry Exam (Aptitude Test) to determine eligibility into the Program.
Please Upload a recent photo of yourself. Smile!

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Notes or Comments for Miss Kennedy
Would you like to be sent your custom most current interest-free payment plan options?
I understand that the 6-Week Receptionist & Insurance program is currently UNAVAILABLE.
Please Read:

Choose between these options

1. An Application Fee is necessary for the application. It does not secure your seat in your requested class, it will only send your application!

OR

2. Making a deposit will enroll you in the class of your choice, by immediately securing your spot! The Application Fee is included in the Deposit. This will ensure your spot is safe!
1. Application Fee $30.00
2. Deposit Fee $600
3. Full Class Tuition $4600
*The Application Fee is non-refundable. If the student is not accepted into the program and a Deposit Fee is made a refund of $570 (Application Fee deducted) will be given on original payment method. *All enrollments regardless of payment choices are still under the admissions committee review until accepted into the program. *Be selecting Option 2 ($600 Deposit Fee) you do not have to pay the Application Fee, all monies paid will be credited towards tuition*
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Student Application

Dental Assisting Academy of the Palm Beaches Assessment