New York State Dental Foundation

Submit Your Verification of Course Completion

This form allows you to submit your verification of cource completion continuing education electronically to the New York State Dental Association's Continuing Education Registry. In order to use this service you must upload verification of course completion in one of the following formats: .pdf, .doc, .docx, or an image file from a scanner (e.g. .jpeg). After clicking "Submit Records" you will receive an immediate written confirmation to the e-mail you supplied that your records have been received. This form will allow you to submit up to five separate verification of course completion. If you have more than five, please repeat the process after submitting the form.

Please note, that it may take up to 5-7 business days for your continuing education records to appear on your registry.

Name * Title First Last Suffix
Please enter your first and last name.
Email *
Phone Number * ### - ### - ####
A phone number is required in the event we need to contact you.
ADA Number *
Must be between 9 and 9 digits. Currently Used: 0 digits.

In order for your continuing education certificates to be entered accurately, please supply your ADA number. If you are not a member of the ADA please contact the NYS Dental Association membership department at (800) 255-2100.
Attach a Certificate #1
Attach a Certificate #2
Attach a Certificate #3
Attach a Certificate #4
Attach a Certficate #5
Comments:
Would you like to receive quarterly e-mail notices that remind you to submit your certificates of completion? Your e-mail address will not be used for any other purposes. *
Do Not Fill This Out