Dental Examination Forms

The following material contains those forms used by CITA in the administration of its licensure examinations.  These forms are being provided to assist candidates who might wish to become familiar with their content and usage.  These forms are also provided to candidates, on an as needed basis, during the various stages of CITA’s application and examination process.  These forms are for information purposes only and the forms downloaded from this site are NOT for candidates to bring and use during the examination, with the exception of the Treatment Selection Worksheet and Radiograph/Follow Up Care Forms.

In order to view and/or download the forms, Adobe Acrobat Reader is required.

2010 Application Forms

Junior Certification Form

Senior Certification Form

2010 Miscellaneous Examination Forms

Certification of Examination Preparation Form

Certification of Completion of Orientation Form

Dental Assisting Form

Interpreter Form

2010 Periodontal Examination Forms and Grade Sheets

Periodontal Examination Forms and Material Tutorial Packet

Periodontal Progress Form

Oral Assessment Form

Treatment Selection Worksheet

Treatment Selection Evaluation Form

Treatment Evaluation Form

Treatment Selection Grading Room Request Form

Treatment Evaluation Grading Room Request Form

Instructions to Candidate Form

Patient Notification Form

Radiograph/Follow Up Care Form

2010 Restorative Examination Forms and Grade Sheets

Amalgam Progress Form

Amalgam Preparation Grading Room Request Form

 Amalgam Restoration Grading Room Request Form

Amalgam Radiograph/Follow Up Care Form

Amalgam (Preparation and Restoration) Grade Sheets

Composite Progress Form

Composite Preparation Grading Room Request Form

Composite Restoration Grading Room Request Form

Composite Radiograph/Follow Up Care Form

Composite (Preparation and Restoration) Grade Sheets

Modification Request Form

Instructions to Candidate

Patient Notification Form

Exposure Processing Form

Restorative Examination Forms and Material Tutorial Packet

2010 Manikin Examination Forms and Grade Sheets

Endodontic Progress Form

Endodontic Grade Sheets

Prosthodontic Progress Form

Prosthodontic Grade Sheets