Apply for a limited dental intern license

Application attachments

We must have these attachments to process your application.

Proof of Graduation

• One of the following:
  • Original transcript with school seal indicating your date of graduation and degree awarded, or
  • Original, signed letter from the Dean’s or Registrar’s office indicating your date of graduation and degree awarded
  • Foreign trained dentists:
    • An original transcript from your foreign dental school indicating your date of graduation and degree awarded. If the transcript is not written in English, we require an official translation into English.
  • Photocopies are not acceptable

Physician’s Statement

• Examination and signed statement from your primary care physician, physician’s assistant or nurse practitioner that you are medically cleared to practice dentistry. The exam must have been completed within 12 months of application.

Documentation of certifications

Either one of the following documents:

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

Massachusetts Dental Ethics and Jurisprudence Exam

• Answer sheet only
• Request a copy here

If applicable

Criminal Offender Record Information (CORI) Acknowledgment Form

• You will need this if you have answered “yes” to any of the questions in the Good Moral Character Questions section
• 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

Letters of Standing

• Official verification of professional licensure from each state or jurisdiction in which you now hold, or ever have held, a license
• The official letter must include the current status of your license, license number, the official seal and signature of the jurisdiction’s licensing Board, and any disciplinary action taken
• A photocopy of a license is not acceptable
• A copy of a screen shot from the jurisdiction’s licensing Board website is also 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. A copy of the original NPDB report is acceptable.

English Language Proficiency

If your dental degree is from a dental school whose curriculum, including textbooks, was conducted in a language other than English, then you must also include proof of a minimum passing score on the TOEFL or IETLS 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.). Include final disposition of the matter.

Other requirements

A photo of yourself

You will need to attach, where indicated, a color photograph, passport-sized (2” x 2”) or larger.

Affidavit

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

Employment

Please note you must secure employment as a dental intern or full-time faculty member before applying for a limited license.