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    Pre-Enrollment Information

    First Name*

    Last Name*

    Email Address*

    Address*

    City*

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    Zip Code*

    Primary Phone*

    Alternate Phone*

    Emergency Contact*

    Relationship*

    Phone*


    Two Character References

    1. Name*

    1. Relationship*

    1. Phone*

    2. Name*

    2. Relationship*

    2. Phone*

    Course Information

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    More Information About Reference

    Are you Military or Military Spouse?
    YesNo


    Medical Information

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    Allergic To Latex?*
    NoYes

    Medical Conditions

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    Education

    Highest Level of Education*

    Year Graduated / Last Year Attended*


    Employment

    Most Recent Employer*

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    Dates Employed*

    Phone*

    Upcoming Classes

    Start Date: January 4, 2021

    Monday & Wednesday: 9:00AM – 1:15PM

    Start Date: January 29, 2021

    Friday: 9:00AM – 3:30PM

    Start Date: February 23, 2021

    Tuesday & Thursday: 9:00AM – 1:15PM

    Start Date: March 22, 2021

    Monday & Wednesday: 5:15PM – 9:30PM

    Read more about…

    Classroom Hours

    • Monday9am - 6pm
    • Tuesday9am - 6pm
    • Wednesday9am - 6pm
    • Thursday9am - 6pm
    • Friday9am - 6pm
    • SaturdayClosed
    • SundayClosed
    Instructors

    Karen Vess
    Founder / Instructor
    Karen brings over 42 years of experience and expertise to…
    Alisha Tate
    Instructor
    Alisha is an Expanded Functions Dental Assistant Certified by the…
    Sonya Denham
    Instructor
    Sonya is a Registered Dental Assistant. She has worked as…
    Contact Info