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 applicants, 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.

Dental Examination
 

Dental Hygiene Examination

Part IV, Periodontal Examination Forms

Periodontal Progress Form

Oral Assessment Form

Treatment Selection Worksheet

Treatment Selection Evaluation Form

Treatment Evaluation Form

Grading Room Request Forms (Treatment Selection and Evaluation)

Instructions to Candidate Form

Follow Up Care Form

Violation of Examination Protocol Penalty Form

Part V, Restorative Examination Forms

Amalgam Progress Form

Composite Progress Form
 

Amalgam (Preparation and Restoration) Grading Room Request Forms   

Composite (Preparation and Restoration) Grading Room Request Forms
 

Amalgam (Preparation and Restoration) Grade Sheets

Composite (Preparation and Restoration) Grade Sheets
 

Modification Request Form 

Instructions to Candidate

Follow Up Care Form

Violation of Examination Protocol Penalty Form

Dental Hygiene Examination

Dental Hygiene Progress Form

Oral Observation Form

Treatment Selection Worksheet

Treatment Selection Evaluation Form

Treatment Evaluation Form

Grading Room Request Forms (Treatment Selection and Evaluation)

Instructions to Candidate Form

Follow Up Care Form

Violation of Examination Protocol Penalty Form