EmailMeForm
2021 NBC Course Approval Request Form
Please complete and submit this form at least 30 business days before the program date.
This information will be used for those who search for available courses on the NBC and Foundation for Dental Laboratory Technology’s websites.
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I. General Information
Please provide speaker/course provider information.
Speaker Name
*
Prefix
First
MI
Last
Suffix
NOTE: if group or panel course, will be documented under first name listed
Professional Designation
Select Credential
CDT
RG
DDS
DMD
MD/DO
Other
(please attach bio.CV for first time approval)
Speaker CDT/RG #
(if applicable, ex. 000000-00)
Speaker Email
Speaker Contact Number
###
-
###
-
####
Speaker a member of NADL?
Yes
No
Additional Speaker 1
(if applicable)
Additional Speaker 2
(if applicable)
Course Provider Organization
(if applicable)
II. Course Information
If the program will be presented by the same speaker multiple times in a given year, multi-date approval will be granted.
Course Title
*
(limited to 75 characters)
Credit Hours
*
(hour per hour basis)
Program Date for Single-Date Course
MM
/
DD
/
YYYY
(only enter date for single-date course)
Program Year
(only enter for multi-date course)
Brief Program Description
(attach outline or syllabus if preferred)
Please provide a link to your online course, if applicable/available
Course Outline
(if applicable)
Type of Credit
*
Regulatory Standards
Scientific
Professional Development
(select one)
Requests for Scientific and Regulatory Standards courses will be approved according to content*, and when the speaker has a CDT, DDS, or other equivalent international accreditation. Other courses will be approved for professional development credit.
*Content for Regulatory Standards courses: Infection Control, OSHA, HIPAA, FDA Regulations, Bloodborne Pathogen Standards, Emergency Actions plans, etc.
*Content for Scientific courses: anything pertaining to the dental technology field
*Content for Professional Development courses: Marketing, Business skills, Communication skills, etc.
Complete Dentures
*
YES
NO
Partial Dentures
*
YES
NO
Crown & Bridge
*
YES
NO
Ceramics
*
YES
NO
Orthodontics
*
YES
NO
Implants
*
YES
NO
CAD/CAM
*
YES
NO
(required to be searchable online)
Delivery Method
Live Webinar
Online Course
In Person Seminar
Magazine Article
Video
Textbook/Reference Material
Please note that webinars that will be presented live and then made available on demand will be approved as Multi-Date courses.
Educational Level of Course
Beginner
Intermediate
Advanced
Master
Prerequisite Knowledge
Yes
No
Learning Objectives
1
/
3
Total
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