Applicant Information First * Last * Address Street 1 Address Street 2 City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Contact Information Daytime Phone Evening Phone Email * Preferred Class Time Session Weekday Weekend Location Mount Vernon, OH Marion, OH Powell, OH Cost The Dental Assisting Program fees are $4320.00. A non-refundable registration fee of $135 and a book fee of $195 will hold your place in the class. The registration fee is deducted from the program total. Payment arrangements must be finalized at open house. First Impressions Dental Assisting Program accepts cash, check, credit cards. How did you hear about us? Referral Source School Newspaper Friend / Family Member Mailer Other Questions or Comments: * Check to confirm * I understand that submitting this form does not guarantee placement in this program. A non-refundable registration fee of $135 and a book fee of $195 will hold your place in the class. You will be contacted by our staff upon receiving your pre-registration form.