University of Southern Indiana

Combined Registration Form

Thank you for choosing to register for the Coronal Polishing and Fluoride Application Combined Certificate Programs. You can begin the registration process below. Please complete all applicable fields of this form. Required fields are denoted by *.

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Course Information

You are registering for the following course:

Coronal Polishing and Fluoride Application Combined Certificate Programs

Please Note

Proof of graduation from a dental assisting program accredited by the Commission on Dental Accreditation of the American Dental Association or proof of one (1) or more years experience in dental assisting. Employer Dentist must submit a letter on company letterhead verifying experience and include the Dentist signature and daytime phone number for follow-up. Access to the online component of the program will not be granted until the documentation is received and verified. Please fax to Kim Parsons, Program Director at 812-461-5356 (USI CNHP; Attn: Angie Bledsoe) or mailed to the following address:

Dental Assisting Program
Attn: Kim Parsons, Program Director
8600 University Blvd
Evansville, IN 47712

Payment Information

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