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.
2012 Application Forms
Junior Certification Form
Senior Certification Form
Dental School Codes
Dental Facility Fees
2012 Miscellaneous Examination Forms
Certification of Examination Preparation and Orientation Form
Dental Assisting Form
Interpreter Form
Incident/Disclaimer Form
Example of Patient-Based Examination Schedule
Example of Manikin-Based Examination Schedule
Review and Appeals Application
2012 Test Site Facility Information
LSU School of Dentistry
University of Alabama School of Dentistry
UMC School of Dentistry
UNC School of Dentistry FEBRUARY examination
UNC School of Dentistry APRIL examination
UPR School of Dentistry
2012 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 (Updated 11/23/11)
Treatment Evaluation Form
Treatment Selection Grading Room Request Form
Treatment Evaluation Grading Room Request Form (Updated 11/17/11)
Instructions to Candidate Form
Radiograph/Follow Up Care Form
2012 Restorative Examination Forms and Grade Sheets
Restorative Examination Forms and Material Tutorial Packet
(updated 02/02/2012)
Class II Progress Form (updated 02/06/2012)
Class II Preparation Grading Room Request Form (updated 02/06/2012)
Class II Restoration Grading Room Request Form
Class II Radiograph/Follow Up Care Form
Class II (Preparation and Restoration) Grade Sheets
Class III Progress Form
Class III Preparation Grading Room Request Form (updated 02/06/2012)
Class III Restoration Grading Room Request Form
Class III Radiograph/Follow Up Care Form
Class III(Preparation and Restoration) Grade Sheets
Modification Request Form
Instructions to Candidate
Exposure Processing Form
2012 Manikin Examination Forms and Grade Sheets
Endodontic Progress Form
Endodontic Grade Sheets
Prosthodontic Progress Form
Prosthodontic Grade Sheets (updated 01-11-12)