NBDE PART I APPLICATION INSTRUCTIONS

You should obtain or retrieve a DENTPIN from www.ada.org/dentpin.aspx before proceeding

with your application.

The information that you provide on the application will be used exactly as provided for all data
processing and mailing functions. To avoid errors, please complete the entire application and
proofread carefully.

For questions regarding the application process, please contact the JCNDE at 800.232.1694.
The electronic application is available at www.ADA.org. To request a paper application, please
contact the JCNDE at 800.232.1694.

The following information is applicable for the electronic or paper application.

Date of Birth
Indicate the month, day, and year of your birth.

Daytime Phone Number

Enter your daytime phone number.

Deans Certification
For dental students in an accredited dental school, the application must be approved by the
dean (or designee) certifying that you are prepared in all subjects on the NBDE Part I. If you
are a dentist, a dental graduate or dental student from a non-accredited dental school, please
refer to the NBDE Part I Guide for eligibility requirements.

DENTPIN
As part of the application process, all candidates must provide their Dental Personal Identifier
Number (DENTPIN). The DENTPIN is a unique personal identifier for applicants and students
involved with the U.S. dental education system and standardized testing programs.

The DAT, ADEA AADSAS and TMDSAS, plus ADEA PASS, ADEA CAAPID, the National Board
Dental Examination program and the National Board Dental Hygiene Examination program all
use the DENTPIN for identification of students and test-takers and for the confidential and
secure reporting, transmission and tracking of test results and academic data.

To avoid delays in processing your application and score requests, please be sure that the
information you provide is accurate (legal name, date of birth, and DENTPIN).

If you modify your address, e-mail address, etc. in the DENTPIN system, your application or
score report request is not automatically updated; please submit your request for updates to
nbexams@ada.org or by fax (312.587.4105).

Educational Background
In order to take the NBDE Part I, you must meet the eligibility requirements and provide the
appropriate documentation. Please refer to the NBDE Part I Guide. Applications that do not
meet the eligibility requirements will not be processed.

Students enrolled in an accredited dental school must have their applications approved by the

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dean (or designee). Other candidates must submit the appropriate documentation to establish
eligibility.

If you are a graduate of, or a student from an accredited dental school, please enter the name of
the dental school that you attended or attend. This is the school that awarded, or will award you
a DDS or DMD degree.

If you are not a graduate of, or a student from a currently accredited dental school, please
indicate your eligibility status by using one of the following codes.

11 Dentist; (Graduate of an accredited U.S. or Canadian Dental School)

33 Dental student attending a non-accredited dental school; (not accredited by CODA or

CDAC).

99 Dental graduate of a non-accredited dental school; (not accredited by CODA or CDAC).

Enter the name of the dental school that granted or will grant you a DDS/DMD degree. Enter
the city, state, and/or country. Please provide the appropriate documentation with your
application.

E-mail Address
Enter your e-mail address, preferably your personal (not college/university) email address.
Many college/university spam filters block the delivery of your eligibility letter.

Fee
Electronic application: the fee will be collected using a credit card during the application
process.

Paper application: send money order/certified check made payable to the American Dental
Association for the total amount with your paper application and any required documentation.
Members of the ADA or ASDA may write a personal check, but your membership number must
be recorded on the check.

Mailing Address
Enter the address to which your results should be mailed. (Score processing can take up to
four weeks, please ensure you will receive mail at this address four weeks after you test).

If you have an apartment number, enter it. Enter the name of the city. If your mailing address is
in the United States or Canada, enter the appropriate two letter, U.S. state, U.S. territory or
Canadian Province abbreviation. If your address is outside the USA or Canada, leave these
entries blank. Enter your U.S. zip code or Canadian postal code. Other countries leave these
entries blank. Enter the appropriate country code. If other, enter the name of the country in the
space provided. For other countries, provide any other mailing information that may be
necessary.

If your address changes after you submit your application and before your results are
reported, you must update your DENTPIN record and notify the JCNDE. If you modify your
address, e-mail address, etc., in the DENTPIN system, your application or score report request
is not automatically updated; please submit your request for updates to nbexams@ada.org or

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by fax (312.587.4105).

Name
Enter your legal name: last name, first name, and middle name. Submit a name change
request with documentation to nbexams@ada.org or by fax (312.587.4105).

Signature
By checking the box or by signing the application, you confirm that: 1) the information provided
is true and accurate; 2) you have read the Examination Regulations and agree to abide by
them; 3) you agree to resolve any legal differences by arbitration; and 4) you give permission for
release of your scores to the institutions requested.

Testing Accommodations
If you are requesting testing accommodations, check the yes box and refer to the testing
accommodation information in the NBDE Part I Guide.

Testing History
Indicate whether you have previously taken the NBDE Part I. If yes, please enter the former
name used, if different from your current name.

Year of Graduation
Enter your (anticipated) year of graduation from the dental school identified.