Dental Assistant Application

  • Name
  • Program acceptance and offers will be made by email to the student’s MECC email account. Please check your MECC email account regularly, a minimum of once daily.
  • Address
  • (If applicable)
  • MM slash DD slash YYYY
    (If applicable)
  • Max. file size: 50 MB.
    (If applicable)
  • MM slash DD slash YYYY
  • Max. file size: 50 MB.
  • Max. file size: 50 MB.
  • Colleges AttendedDates AttendedDegrees Received 
  • I understand that all information on this application is subject to verification and I consent to a criminal history background check and drug screen. I understand that falsification of any portion of this application may be reason for my withdrawal from the Dental Assistant program. I certify the above stated information is accurate to the best of my knowledge.
  • MM slash DD slash YYYY