Ontario Application Dental Assisting Program Name (First & Last)(Required) Middle Name Former Surname (if applicable) Also Known As (if applicable) Date of Birth(Required) MM slash DD slash YYYY Gender(Required)MaleFemaleUnspecifiedPhone (no - or brackets please)(Required) Email(Required) Address(Required) Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code (A1A 1A1) Legal Status(Required)1 Canadian2 Permanent Resident (formerly Landed Immigrant)3 Student Visa4 Other Visa (e.g. Working Visa)5 Non-Canadian, no visa as student is studying outside of Canada6 Not Reported/UnknownRequested Intake Date(Required) MM slash DD slash YYYY Intakes start on the last Monday of each monthEmployer Name (Dentist) and Dental Office Name(Required) It is a requirement to have been working in a dental office for a minimum of 3 months prior to enrollment.Is your Sponsoring Dental Office part of a DSO (dental service organization)?(Required)N/Adentalcorp123dentistDentaLookPassion Dental GroupOtherSponsoring Dentist Email?(Required) Dental Office Mailing Address(Required) Are you applying with your transcripts or as a mature student?(Required)High school transcriptsMature StudentUpload Transcripts (if available).Max. file size: 128 MB.Have you attended a Dental Assisting program in the past?(Required)NoYesWhich Dental Assisting Program did you attend?(Required) Did you complete the program?(Required)YesNoWill you be applying for student accessibility services?(Required)NoYesPlease upload any supporting documentation (if available).Max. file size: 128 MB.How did you hear about Risio Institute?(Required)Dental Conference (PDC/ODA etc.)Google searchMember of dental officePast or current student of the programSocial media (Instagram/Facebook etc.)OtherAre you a permanent resident of Canada?(Required) Are you a permanent resident of Canada? I agree to receive communication from Risio Institute for Digital Dental Education.(Required) I agree to receive communication from Risio Institute for Digital Dental Education. Δ Application Questions? Book a virtual meeting with the Risio Registrar, Tanya Lewis! Book
