CERTIFICATION OF ELIGIBILITY

NATIONAL BOARD DENTAL EXAMINATION PART I

(Dental students enrolled in a non-accredited dental school)

This form is for students who are enrolled in a dental school that is not accredited by the
ADA Commission on Dental Accreditation.

This completed form must be received by the JCNDE for each NBDE Part I application
submitted. The NBDE Part I application process is not complete without this form. A
DENTPIN must be included on the form in order for the JCNDE to attach the form to the
correct file. If you do not have a DENTPIN you must register for one through the DENTPIN
homepage (www.ada.org/dentpin) prior to submitting a Certification of Eligibility form.
Certification of Eligibility forms that the JCNDE cannot match to a DENTPIN will not be
retained.

I certify that ______________________________________ (name of student) is currently

enrolled in this dental school and has successfully completed all subjects included in
the NBDE Part I: Anatomic Sciences, Biochemistry-Physiology, Microbiology-Pathology, and
Dental Anatomy and Occlusion.

Signature of Dean or Registrar

Printed Name of Dean or Registrar

Dental School Name

Dental School Address

DENTPIN

SCHOOL SEAL (Embossed)

________________
Date

Mail completed form to: JCNDE, 211 East Chicago Avenue, Suite 600, Chicago, IL 60611-2637

4/10/2015