Application - Houston Dental Careers

Personal Information

Name*
First Middle Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Method of Payment
I Have Selected The Following Payment Plan (see note below about deposit to assure place in next class)**
- OPTION 1: $4300 On Or Before First Day Of Class
- OPTION 2: $4450 With Payment Installments
- OPTION 3: $4700 With Payment Installments
How Did You Hear About Us?
Please Choose One of the Following
- Friend
- Internet
- Newspaper
- Other
Note: A minimum deposit of $500 is required to guarantee your place in the next class. Class space is limited to the first twenty students accepted. Any applicant who is not accepted by Houston Dental Careers will receive a complete refund of any deposit or payments.