EXPANDED FUNCTION DENTAL AUXILIARY (EFDA)
2017-2018
BEFORE SUBMITTING
Application Period: January 3, 2017 to June 1, 2017
THIS APPLICATION
Last Name
Review the admissions
criteria and application
process outlined on the
reverse side of this form.
Complete the SPSCC
Admission Application.
Activate your SPSCC email
account. Information will be
sent only to an SPSCC email
address.
Pay the $25 application fee
and submit the receipt with the
application or submit the
payment (check/money order)
with the application. The fee
is non-refundable.
Applicants are responsible for
making sure all required
documents are received.
Incomplete applications will
not be processed or
returned.
Previous Names (If Any)
First Name
Date of Birth
M.I.
Phone Number
Student ID Number
Email Address
1. Required Supporting Documentation
(check the box for each required item that you have and submit these items with this application)
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Copy of your current RDA credential
Copy of a Photo ID card
Proof of Hepatitis B inoculation or immunity
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Sponsoring Dentist Commitment Form signed
Proof of DA program completion if applicable
Copy of your Healthcare Provider CPR Card
Copy of your current CDA certificate if applicable
2. Certification
Are you currently certified (CDA) with the Dental Assisting National Boards?
(If yes, please attach a copy of your current certificate.)
3. Education and Training (check one)
☐
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☐ Yes ☐ No
Graduate from a Commission on Dental Accreditation (CODA) Dental Assisting Program
(attach a copy of Certificate of Completion or proof of completion with name of school and year graduated)
Graduate from a non-accredited Dental Assisting Program
(attach a copy of Certificate of Completion or proof of completion with name of school and year graduated)
Education/trained on the job in the profession of Dental Assisting
(list dental practice(s) at which training took place and include dentist’s name and contact information):
1.
TO SUBMIT THIS
APPLICATION
In Person
One Stop in Building 22
One Stop at Lacey Campus
2.
4. Employment Information
(list employer(s) where you have assisted in restorative procedures for three of the last five years)
Dentist
Dates
Telephone Number
1.
2.
Mail
SPSCC
Attn: Rob Masterson
2011 Mottman Road SW
Olympia, WA 98512-6292
3.
EFDA students must follow all WISHA/OSHA protocol for infection control, hazardous materials / waste, and
patient / operator safety. Access to a computer, internet, and email is mandatory. Your signature below
certifies that you have read, understood, and agree to comply with the requirements for the Expanded
Function Dental Auxiliary (EFDA) program.
Student Signature
CONTACTS
Application Questions
Rob Masterson
[email protected]
Curriculum Questions
Dr. Dana Larson (Director)
[email protected]
or
Cozette Polzin (Instructor)
[email protected]
Date
South Puget Sound Community College’s equal opportunity policy prohibits discrimination in our services and in employment against any person on the
basis of race or ethnicity, creed, color, national origin, sex, marital status, sexual orientation, sexual identity, age, religion, Vietnam-era or disabled veteran
status, or the presence of any sensory, physical or mental disability except in the case of a bona fide occupation qualification. South Puget Sound
Community College is an equal opportunity/affirmative action employer and complies with the Americans with Disabilities Act (ADA). The college’s ADA
coordinator is the chief human resources officer, 2011 Mottman Rd SW, Olympia WA 98512, (596-5360). Students who need disability accommodation
should contact Disability Support Services in Building 22, second floor, email [email protected] or call (360)596-5306.
This Section is for Staff Use Only
Notes
☐ EFDA Application
☐ Dentist’s Statement
☐ Payment Receipt
Date Received
EXPANDED FUNCTION DENTAL AUXILIARY (EFDA)
2017-2018
ADDITIONAL INFORMATION
Application Period: January 3, 2017 to June 1, 2017
Admissions Criteria
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Three years of chairside dental assisting experience in the last 5 years
Current RDA credential
Proof of Hepatitis B inoculation or immunity
Employment with a ‘sponsoring dentist’ who provides mentoring, instructional support, and the clinical aspect of the last
quarter in the program. More information for the sponsoring dentist is located on the last page of this application.
Passing scores on SPSCC pre-entrance exams: Chairside (written multiple choice – questions covering basic chairside
assisting information) and practical coronal polish, sealants, and radiographs on simulators. Pre-entrance exams
evaluate an applicant’s knowledge of basic chairside assisting, their ability to place sealants, perform coronal polishes,
and capture a diagnostic, full-mouth set of intra-oral radiographs.
Current Healthcare Provider CPR card
If applicant is NOT a graduate of a CODA dental assisting program, he or she MUST be a current CDA (Certified Dental
Assistant). A copy of the Certificate or test results must be attached to the application. A Dental Assisting Course will be
provided through the EFDA Program to satisfy Washington State’s credentialing requirements for assistants who did not
complete a program accredited by CODA but are certified.
Application Process
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Complete South Puget Sound Community College EFDA application and submit it with a $25.00 non-refundable fee.
Provide all documentation required on the EFDA application.
Incomplete applications will not be processed or returned.
Deadline for completed applications to be received by SPSCC: June 1 of the application year, however, late
applications may be considered by Program Director if openings are available. Enrollment is limited to 15. The
Program Director and SPSCC will keep application and submitted materials to be applied to the fall enrollment.
Priority consideration for the pre-entrance exam will be given to the first 18 applicants with complete applications.
Applicants will be notified by June 10th if they have or have not been selected to take the pre-entrance exam
administered in July. The applicant’s assigned exam date will be given at this time. Exam packets will be sent to help the
applicants plan and prepare for the exam. Applicants will be notified of acceptance or alternate status within one week
after all testing is completed.
IF ACCEPTED INTO THE EFDA PROGRAM, STUDENTS WILL RECEIVE AN INFORMATION PACKET.
The packet will include a detailed list of needed supplies and materials to help them prepare for the first day of class.
Additional Program Information
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The Expanded Function Dental Auxiliary (EFDA) is a licensed health care professional who is an integral member of the
dental health team and can deliver services in a variety of settings from private dental practices to schools and
community dental clinics.
Besides the tasks presently allowed by law for the Registered Dental Assistant, the EFDA can place and finish amalgams
and composite restorations as well as take final impressions.
The EFDA can provide care under general supervision (dentist not present in office at the time) to include: coronal polish,
sealants, fluoride treatment and exposing / processing dental radiographs.
Licensure is granted by Washington State Department of Health. To become a licensed EFDA the applicant must
successfully complete EFDA courses approved by the Dental Quality Assurance Commission, pass the Washington State
Restorative Exam (WARE) written exam and the Western Regional Examining Board (WREB) practical exam. EFDA
courses at South Puget Sound Community College are designed for the working Registered Dental Assistant. The
courses are rigorous and are intended for committed and dedicated RDAs.
Classes are held on Tuesdays from 5:30 to 8:30PM.
EXPANDED FUNCTION DENTAL AUXILIARY (EFDA)
2017-2018
ADDITIONAL INFORMATION
Application Period: January 3, 2017 to June 1, 2017
Expanded Function Dental Auxiliary (EFDA) Courses:
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The EFDA courses consist of three credit bearing classes. All three courses (Dent 200, 201 & 202) must be taken in succession starting
with Dent 200 in the fall quarter.
Only students with a grade of ‘B’ or better in each quarter class will be able to register for subsequent courses. Course content includes
didactic, laboratory, and clinical components.
Students must pass all three courses to successfully complete the EFDA program at South Puget Sound Community College and, thus,
qualify to take the WARE (Washington Restorative Exam) and WREB (Western Regional Examining Board).
CREDITS
LECTURE
HOURS
LAB HOURS
CLINIC HOURS
(in office)
TOTAL
HOURS
Dent 200 – Fall Quarter
Dent 201 -- Winter Quarter
Dent 202 – Spring Quarter
2
3
4
11
11
11
22
22
22
0
33
66
33
66
99
Total EFDA Curriculum Credits/Hours
9
33
66
99
198
COURSES
Program Costs (dollar amounts are approximate and subject to change):
Fee
Cost
Application Fee
Tuition
Lab Fees
Lab Kit
Acadental Typodont & Teeth
White Full Length Lab Coat
Personal Protection Equipment
Textbooks (2)
Loups Eye Wear and Light
Malpractice Insurance
$ 25.00
$ 1,200.00
$ 120.00
$ 1,000.00
$ 700.00
$ 35.00
$ 50.00
$ 250.00
$ 1,000.00
$ 18.00
TOTAL
$ 4,400.00
Notes
Total - Subject to change by legislature
$ 40 per quarter
Varies depending upon what the sponsoring dentist provides the student.
Subject to change due to manufacturer pricing and need for more teeth.
Dependent upon manufacturer and the student’s preference.
Yearly Fee
Additional Costs
The costs listed below are not program costs at South Puget Sound Community College, but costs to become licensed by the
State of Washington. They are listed for information only.
EFDA State Licensure
WARE: Washington Restorative Exam, Written
WREB: Western Regional Examining Board,
Restorative Exam
$175.00
$275.00
TOTAL
$965.00
$515.00
Additional Class Registration Steps
If you are accepted to the EFDA program, as a student of South Puget Sound Community College, you will need to complete
the following prior to registering for classes.
1. Students need to have an updated admissions application on file with Enrollment Services. Admissions needs to be
updated if the applicant has previously applied and has not attended for more than two consecutive quarters since the last
application. If needed, students may apply or reapply at https://spscc.edu/apply.
2. Students need to activate their SPSCC email address at https://spscc.edu/students/email. The student’s SPSCC email
address is the student’s login for the college network and Office 365. All college correspondence will be sent to this email
account, and the student is responsible for checking their account regularly or forwarding it to their preferred account.
3. Complete the mandatory New Student Advising and Registration either in person or online. More information is available
at https://spscc.edu/start/registration.
Sponsoring Dentist Statement of Commitment
Expanded Function Dental Auxiliary (EFDA)
2017-2018
Application Period: January 3, 2017 to June 1, 2017
Applicant’s Information
Applicant’s Last Name
Applicant’s First Name
M.I.
Sponsor’s Information
Sponsoring Dentist’s Last Name
Sponsoring Dentist’s First Name
Street Address
City
Email Address
State
M.I.
Zip Code
Phone Number
Information for the Sponsor
Thank you for considering being a sponsoring dentist for the applicant listed above. The Expanded Functions Dental
Auxiliary Program at South Puget Sound Community College is a partnership between the dental community, student and
the college. All play vital roles in the student’s success. The sponsoring dentist contributes by:
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Providing the employee / EFDA student with the preceptorship site second and third quarters for taking final impressions
and placing and finishing 64 required restorations in patients who have been screened and chosen by the dentist.
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Complete written evaluations (provided) for each composite and amalgam placed
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If you do not use amalgam as a restorative material, help the student secure needed sites where student can
place/carve required amalgam restorations
.
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Guiding and mentoring the EFDA student as he/she practices placing amalgam and composite restorations in assigned
typodont teeth.
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First quarter, helping to evaluate the student’s restorations in typodonts using the evaluations provided by the college.
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If possible, providing (temporarily) needed restorative instruments, dental materials and a high speed handpiece for the
student from your office. Students can also purchase these instruments and materials through an arrangement with
Smart Practice. It is not expected that the sponsoring dentist provide these items, but if they are provided, it is very
much appreciated.
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Sponsoring dentists need to provide contact information to receive pertinent information including review of the
preceptorship and other responsibilities.
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Signing a contract agreement with SPSCC. This agreement is for the dentist’s protection as well as the college and is a
very basic contract. FYI: Students will be required to purchase malpractice insurance from the college before starting
the preceptorship in your office.
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Contacting the professor regarding any concerns or questions as needed.
This form must be signed by the sponsoring dentist, attached to the student’s application, and turned into the college before
the student can be considered for testing and registration.
☐
I have read the Sponsoring Dentist Statement of Commitment and agree to help the EFDA student /employee
accomplish the goals of the program at South Puget Sound Community College.
Sponsoring Dentist’s Signature
Date