APPLICATION FOR REVIEW AND ASSESSMENT PRIOR TO LICENSURE
INTERNATIONAL APPLICANTS PERSONAL INFORMATION/CONTACT INFORMATION Surname and given name(s) of candidate at birth____________________________________________________________
Surname and given name(s) of candidate if different than above________________________________________________
Year of birth________ Country of post-secondary study_____________________________________________________
Are you a Canadian citizen?______ If not, are you a landed immigrant?_________________________________________
Home address:____________________________________________________Daytime telephone no:_________________
Address of place where you principally practice your profession: _______________________________________________
Office telephone number: _______________ Fax number: ________________ Email:_____________________________
CURRENT/PREVIOUS JURISDICTION LICENSURE Type of license currently held: Full/Active (no conditions from previous or current jurisdiction)
Conditional/Temporary/Provisional (please provide details):
List any additional educational requirements or continuing practice requirements imposed by your current regulatory body, as a condition of your licensure:_________________________________________________________________________
TEACHING INSTITUTIONS ATTENDED:
NUMBER OF YEARS IN PRACTICE:________
Country/Countries of Practice_____________________________________________________________
EXPERIENCE WITH REMOVABLE PROSTHESIS:_____________________________________
It is generally recommended that international applicants attend a recognized Canadian School of Denturism; however, in extenuating circumstances, applicants who hold an international degree in Dentistry may be accepted; these candidates will be asked to take a practical examination to determine their skill level. International applicants will be assessed based on prior learning on complete and partial dentures. A $4000.00CDN Examination Fee will apply. We do not accept applicants who are educated in Dental Technology. Patients are supplied. Based on the results of the practical examination, the Admissions Committee will recommend to the Denturist Board of Manitoba if the applicant should be accepted as an Intern in the Province of Manitoba, for a period of time to be determined by the Admissions Committee. Internship is served under the direct supervision of a licensed Denturist in Manitoba.
Candidates must verify their education documents by applying to Worldwide Education Services (WES) at http://www.wes.org/application/apply_now.aspt. The cost of this evaluation is the responsibility of the candidate. Applications can either be submitted online or mail by printing out a PDF copy of the form (note: there is a $30 processing fee for paper applications). Candidates are to apply for a WES Basic Comprehensive Course by Course Evaluation and the Denturist Association of Manitoba must be selected as a recipient of a second copy of the evaluation. We will not accept evaluation reports from candidates, we will only receive reports directly from WES. The candidate will attach the following documents:
A copy of the first page of passport
An attestation that the candidate holds a recognized diploma in accordance with the Agreement on Internal trade (Canadian Mutual Recognition Agreement Chapter 7)
Proof, where required by law, of the candidate’s knowledge of the official language (via TOEFL on-line English assessment test and/or in-person interview)
Annex “A” duly completed
Authorization for collection of information
Letter from current regulatory body confirming membership status, license class (if applicable) and attesting the applicant is a member in good standing.
A cheque covering fees for opening the file ($250.00 CDN)
Contact the Admissions Chair in the event you can not produce documents listed above. In lieu of documents that are unavailable for submission (i.e. loss, translation not available), the Admissions Chair may verbally question and assess the applicant.
Registration decisions will usually be made within 5 days. More complex decisions might require more time.
Dependent on the results of the prior learning assessment, education level, skills, training, practical examination, or the information provided in Annex A herein, the Admissions Committee may choose to not recommend to the Board of Directors that an applicant be approved for licensure or internship. If the decision of the Admissions Committee is in dispute, the applicant may submit a Request for Appeal, in writing, within 30 days, to the Internal Review-Audit Committee of the Denturist Association of Manitoba. Procedures for appeals are available by contacting the association office.
Applicants may also request, in writing, that the Admissions Committee release any and all records relating to the original application that are in its custody or under its control, excepting in circumstances outlined in the Fair Registration Practices in Regulated Professions Act Section 10 (2). Reasonable cost recovery may be assessed, depending on any regulations to the Act.
Current Registration and Internship Fees
Intern fees (non-prorated) are $200.00 per annum. Professional fees for licensed denturists (non-prorated) are approximately $3300.00 per annum, plus applicable tax, plus mandatory malpractice insurance (currently $165.00 per annum).
Are you or have you ever been a member of another professional governing body other than denturism?
DENTURIST BOARD OF MANITOBA Complete the top section of form and mail to the Board of each province or state in which you are now or have been licensed to practice. If needed, you may make duplicates of this form.
Secretary: I am applying for licensure to practice denturism in the Province of Manitoba. The Denturist Board of Manitoba requires that you complete this form in order that I may be considered for licensure
This is my authorization to release any information in your files favorable or otherwise, to the Denturist Board of Manitoba
Return to Denturist Board of Manitoba, PO Box 69012, RPO Tuxedo Park, Winnipeg MB R3P 2G9
I,___________________________ Registrar of ________________________________________
hereby certify that _____________________________________________ was granted certificate
number_____________________ dated____________________________ to practice denturism.
STATUS OF LICENCE: current expired date expired:____________________
Reason for expiration:_____________________________________________________________
LEGAL/DISCIPLINARY ACTION: Yes No
If yes, please explain______________________________________________________________
Date English Language Proficiency Completed: ___________________
Assessment Decision (All Requirements Met; Some Requirements Met; Applicant Not Suitable:______
__________________ Status after Assessment: (Active; Restricted; Intern; Denied)___________
Details of Restrictions/Recommendations, if any:______________________________________
Deadline for con-ed/upgrades:______________________________________________________
Decision Date: ________________ Date Applicant Notified: _________________________
Licensure/Internship Start Date:_____________ MB Blue Cross Unique ID#________________
(i.e. payment received) YYYYMMDD
APPEALS RECORD Date Appeal Received:____________ Type:_____________