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MANITOBA DENTAL ASSOCIATION 2021735 Cordon Avenue, Winnipeg, MB, R3N 0K4 T: 204.988.5300 F: 204.988.5310 www.manitobadentist.ca IN ORDER TO RESIGN YOUR License, YOU MUST: READ INFORMATION ON BACK
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How to fill out dental assistant cancellation form:

01
Start by entering your personal information, including your full name, address, phone number, and email address. Make sure all the information is accurate and up to date.
02
Next, provide details about the dental assistant program you are canceling. This may include the name of the program, the date you enrolled, and any relevant identification numbers.
03
Indicate the reason for canceling your enrollment in the dental assistant program. This could be due to personal reasons, financial constraints, or a change in career plans. Be concise and clear in explaining your reason.
04
If there are any fees or refunds involved in the cancellation process, make sure to mention them in the form. Include any payment details or indicate if you are requesting a refund.
05
Sign and date the form to confirm that all the information provided is true and accurate. Review the form once again before submitting it to ensure there are no errors or missing information.

Who needs dental assistant cancellation form:

01
Individuals who have enrolled in a dental assistant program but now need to cancel their enrollment.
02
Students who have changed their career plans and are no longer pursuing a career as a dental assistant.
03
Individuals who are facing financial constraints and are unable to continue with the dental assistant program.
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Dental assistant cancellation form is a document used to cancel registration or licensure for a dental assistant.
Any dental assistant who wishes to cancel their registration or licensure is required to file the cancellation form.
To fill out the dental assistant cancellation form, the individual must provide their personal information, registration/license number, reason for cancellation, and signature.
The purpose of the dental assistant cancellation form is to officially cancel the registration or licensure of a dental assistant.
The dental assistant must report their personal information, registration/license number, reason for cancellation, and signature on the cancellation form.
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