Edit, Download, and Sign the ADA CERP New Application Fee Transmittal Form
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How do I fill this out?
To fill out this form, begin by providing your contact information and the details of your CE provider. Next, select the appropriate fee type and payment method. Lastly, ensure all information is accurate before submitting the form.
How to fill out the ADA CERP New Application Fee Transmittal Form?
1
Provide your CE provider information.
2
Select the fee type and method of payment.
3
Fill in your credit card details if applicable.
4
Double-check all entered information for accuracy.
5
Submit the form via mail or fax to the ADA.
Who needs the ADA CERP New Application Fee Transmittal Form?
1
Continuing Education providers needing to apply for ADA CERP accreditation.
2
Dental organizations seeking to register their CE programs.
3
Providers in the U.S. and Canada requiring eligibility determinations.
4
International providers aiming for ADA recognition.
5
Individuals or organizations organizing dental education events.
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1
Open the PDF file on PrintFriendly.
2
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What are the instructions for submitting this form?
To submit this form, mail it to the American Dental Association at 211 East Chicago Avenue, Chicago, IL 60611-2678. You can also fax the form to 312-440-2567. Ensure payment accompanies the application or is submitted separately as directed in the form.
What are the important dates for this form in 2024 and 2025?
Important deadlines for submission will be published at CCEPR.ADA.org. Be sure to review these deadlines carefully to ensure compliance for 2024 and 2025 applications. Stay informed of updates to avoid any submission issues.
What is the purpose of this form?
The purpose of this form is to facilitate the application and fee submission process for CE providers seeking ADA CERP accreditation. It serves as a critical tool for ensuring that all necessary fees are collected and accurately processed. By completing this form, providers can ensure compliance with ADA requirements and improve their educational offerings.
Tell me about this form and its components and fields line-by-line.
- 1. Name of CE Provider: Enter the name of the continuing education provider.
- 2. Address: Complete address of the CE provider.
- 3. City: City of the CE provider location.
- 4. State/Province: State or province where the CE provider is based.
- 5. Contact Name and Title: Name and title of the primary contact person.
- 6. Phone: Contact phone number.
- 7. E-mail Address: Email for correspondence.
- 8. Fee Type: Select the fee type applicable to your application.
- 9. Method of Payment: Indicate whether you are paying by check or credit card.
- 10. Card Number: If paying by credit card, write down the card number.
- 11. Expiration Date: Provide the expiration date of the credit card.
What happens if I fail to submit this form?
Failing to submit this form may result in delayed processing of your application. This can lead to missed opportunities for CE accreditation and potential loss of credits. It's crucial to adhere to submission guidelines to avoid these issues.
- Delayed Application Processing: Late submissions will delay your application review.
- Eligibility Issues: Incomplete or erroneous forms may lead to disqualification from accreditation.
- Wasted Resources: Time and resources spent could be wasted on improper submissions.
How do I know when to use this form?
- 1. New ADA CERP Application: Use this form to submit fees for your initial application.
- 2. Pre-Application Fees: This form is necessary for determining eligibility for CE providers.
- 3. International Provider Fee Submission: International entities need to submit a different fee transmittal form.
Frequently Asked Questions
How do I submit my completed form?
You can submit your form via mail or fax to the specified addresses on the form.
Can I edit the PDF online?
Yes, you can easily edit your PDF using PrintFriendly's editing tools.
What payment methods are accepted?
You can pay via check or credit card, including VISA, MasterCard, and American Express.
Is there a deadline for submissions?
Always check the published deadlines at CCEPR.ADA.org to ensure timely submission.
Can I fill out the form electronically?
Yes, you can use our PDF editor to fill out the form electronically.
What happens if I submit the form late?
Late submissions may result in processing delays or eligibility issues.
Do I need to keep a copy of my submission?
Yes, it is recommendable to keep a copy of your submitted form for your records.
Can international providers use this form?
International providers must use the PPIP fee transmittal form instead.
How can I check the status of my application?
Contact CCEPR directly for information regarding your application status.
What should I do if I make an error on the form?
Simply edit the PDF using our tools before submitting.
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