Dental Assistant Program Pre-Registration Winter 2020

 
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 Dental Program Pre-Registration 
Welcome. Thank you for your interest in our Dental Program. Please use this form to pre-register for our upcoming program. You will receive announcements and other information about this program as we prepare for the program to begin by March 2020.

 
  Lompoc Adult School and Career Center Registration Form Dental Program Winter 2020
   
1.
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Enter your first name as it appears on your legal documents.
 
   
2.
Type your middle name here. Leave blank if you do not have a middle name.
 
   
3.
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Enter your last name as it appears on your legal documents.
 
   
4.
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Enter the street address of your residence
 
   
5.
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Enter the city where you live
 
   
6.
*
 
   
7.
*
 
   
8.
*
 
   
9.
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  Select Date
mm/dd/yyyy
   
10.
 
   
 
 
 
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