Excel Learning Institute Dental Assisting Program Application

Please complete the online application below. Final processing of your application will occur upon completion of this form and required uploaded mandatory documents.

Name:(Required)
Gender:
Are you a US Citizen?(Required)
MM slash DD slash YYYY
Current Address:
Mailing Address:
Leave blank if same as current address above.
MM slash DD slash YYYY
Max. file size: 16 MB.
How did you learn about Excel Learning Institute?(Required)
Do you have access to technology?(Required)
Excel Learning Institute's Dental Assisting Program is 70% virtual and 30% in-person. Do you think you will have a problem having access to and using technology, i.e. a computer?