Apply for a limited dental faculty license

Application attachments

We must have these documents to process your application.

Proof of Graduation

• One of the following:
  • An official, original copy of your transcript from your dental school, indicating your date of graduation and degree awarded
  • An official, original letter from your dental school indicating your date of graduation and degree awarded
• Photocopies of transcripts or copies of diplomas are not acceptable
• If your transcript is written in a language other than English, then we require an official translation into English

Physician’s Statement

• An examination and statement from your primary care provider, nurse practitioner or physician’s assistant that you are medically cleared to practice dentistry. The examination must be completed within the 12 months preceding your licensure application.

Documentation of certifications

One of the following documents:

• Current certification in American Red Cross Cardiopulmonary Resuscitation/Automated External Defibrillation for the Professional Rescuer (CPR/AED)
• Current certification in the American Heart Association Basic Life Support for Healthcare Providers (BLS)
• Current certification in ACLS/PALS

Massachusetts Dental Ethics and Jurisprudence Exam

• Answer sheet only
• Request a copy here

Confirmation of Full-Time Faculty Appointment

• An original letter signed by a school official on institutional stationery, including the dates of your faculty appointment

Criminal Offender Record Information (CORI) Acknowledgment Form

• This form is attached in the application
• This must be signed in person, and witnessed by either a BHPL employee at the Board's offices or a notary public
  • The BPHL employee or notary public must verify your identity through acceptable identification

If applicable

Letters of Standing

• Verification of professional licensure from each state or jurisdiction in which you now hold, or ever have held, a license to practice dentistry or other profession
• This letter must include the current status of the license, your license number, the official seal and signature of the jurisdiction’s licensing board, and any disciplinary action taken
• A photocopy of your out-of-state license is not acceptable

Practice History

• If you have ever practiced dentistry in another jurisdiction or state, please include an up-to-date resume, curriculum vitae, or practice history

National Practitioner Data Bank Self-Query

• Attach if you have ever held a professional healthcare license in the United States
• To request a self-query please contact the Data Bank at (800) 767-6732 or go to the NPDB website
• The Data Bank will mail the report to you. We only accept an original report from NPDB.

English Language Proficiency

If your dental school curriculum was conducted in a language other than English, including textbooks:

• You must attach documentation of a minimum passing score on either the TOEFL or IELTS exam

Good moral standing

If you answer "yes" to any of the moral standing questions on the application:

• Attach a separate sheet explaining the circumstances
• Also provide all relevant certified documentation (police reports, court records, disciplinary action reports, etc.) including final disposition of the matter.

Other requirements

A photo of yourself

You will need to attach, where indicated, a color photograph that is passport-size or larger.

Affidavit

You must sign the affidavit on the application and have it witnessed by a Notary Public.