Student form to be completed

Please complete the form below. Remember to double check all of your information is correct before submitting. We aim to respond within 24 hours.

Title (Please Tick)*

Mr

Mrs

Miss

Ms

Other (Specify)

First Name*

Last Name*

Previous Surname

Date Of Birth*

Day

Month

Year

Email*

Phone*

Do you have the right to work in the UK?*

Yes

No

Are you currently working in a practice?*

Yes

No

Do you have a long term learning difficulty?*

Yes

No

If "YES", please tell us about your learning difficulty

Address*

GDC Number*

Upload a clear image of ID for verification (Passport or Drivers License)*

Upload a copy of your CV*

Upload proof of your GDC Registration (If you have it)

Agree to Terms & Conditions

Dental Training Ltd is registered with the National Examining Board for Dental Nurses and the British Dental Association.

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