NEBDN National Diploma Course Transfer to Dental Tutors Course CourseNEBDN National Diploma in Dental Nursing (only available to students who failed the NEBDN Written or OSCE exam) Title TitleMrMrsMiss First Name (as it appears on your passport) Last Name (as it appears on your passport) Email Address Phone Number WhatsApp number (If you don't have one, you must download it) Name of the Previous Course Provider Date of Birth Full Address including Post Code Nationality Are you currently working as a Dental Nurse? Are you currently working as a Dental Nurse?YesNo Name of the Clinic Part Time or Full Time Part Time or Full TimeFull TimePart Time Which Exam do you need to resit? Which Exam do you need to resit?NEBDN Written ExamNEBDN OSCE ExamN/A Declaration (Please ensure you read every point carefully) Declaration (Please ensure you read every point carefully) I accept to pay a monthly fee of £150 until I pass the both Dental Nurses exams. I understand that if I don't pay monthly fees, my course will be cancelled and discontinued. I understand that any fees paid to Dental Tutors are non-refundable. I understand that I must pay the exam resit fee upon transferring. I confirm that my previous course provider completed the course withdrawal form and submitted it to the NEBDN. Complete