CE Provider Renewal Application | American Academy of Dental Hygiene, Inc.

Continuing Education Provider Renewal Application
Thank you for your interest in renewing your continuing education provider status through the American Academy of Dental Hygiene Inc. Please allow 8-10 weeks prior to the event for the committee review process. You may expedite the process for an additional $100.00 fee. If you have questions contact Danni Gomes at: admin@aadh.org.
Fee schedule:
All fees are non-refundable:
Submission requirements checklist:
Date:*
Today's Date
Full Name of Provider /Organization:*
Address of Provider/ Organization:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address of Provider/ Organization (if different from above):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Contact Person of Provider/ Organization:*

First NameLast Name
Telephone Number: *

Area CodePhone Number
Email Address:*
Please avoid using an email address ending in .edu so our emails won't get blocked
Provider/ Organization is a/an:*
CV/BIO (for additional speakers)

Browse Files

Cancelof
Standards for Quality Continuing Education:

Review, download and save for your reference
Attestation:

Signature required below
As an American Academy of Dental Hygiene (AADH) approved provider, I fully understand the requirements as outlined by the following document.

• Standards of Quality Continuing Education

The guidelines for AADH Provider/Sponsors and Courses must be followed.

By signing below, I agree to follow the guidelines for all Continuing Education programs I present. I also understand that failure to do so may result in the termination of my Approved Provider status.
Provider/ Organization Representative's Signature:*

Clear
Programs:

Upload a spreadsheet of the courses that were given in the past 1-2 years (2-years for corporate). Using this format: Name of Course, Number of CE's, Speaker, Date of Course, Location (City/State) Course code # (refer to acceptance letter for coding system).
Upload course listing here.*

Browse Files

Cancelof
Please note:
Your application will be denied if this form is incomplete. Upon committee approval you will be sent the new AADH provider logo. This logo MUST be utilized on all Certificates of Attendance, along with the required course coding and verbiage. The logo must be utilized for all advertisements as well. The time period of this agreement is one year (two years for corporations) and valid starting on January 1st through December 31st of the year of application.
Certification:

By signing below, I certify that the statements made in this application are true and correct, and that all courses offered for continuing education credit will meet the requirements in the Standards for Quality Continuing Education set forth by the American Academy of Dental Hygiene, Inc.
Provider /Organization Representative's Signature:*

Clear

	Quantity	Price
Expedite Fee (1-2 weeks)		$100.00
Individual Members (1-year)		$175.00
State Associations (1-year)		$275.00
Colleges/Universities (1-year)		$225.00
Colleges/Universities-faculty only (1-year)		$175.00
Components (1-year)		$225.00
Societies (1-year)		$225.00
Study Clubs (1-year)		$225.00
Individual Non-member (1-year)		$350.00
National Association (1-year)		$375.00
International Association (1-year)		$375.00
Corporate (2-years)		$700.00

Continuing Education Provider Renewal Application

Fee schedule:

Standards for Quality Continuing Education:

Attestation:

Programs:

Please note:

Certification:

Payment: