Thank you for your interest in becoming a CDAC Surveyor. Please complete the form below to help us get to know you and attach all required documentation to support your eligibility.

*Please note that incomplete submissions will not be considered.

CDAC Surveyor Application Form

Section 1: Applicant Information

Address
Address
City
State/Province
Zip/Postal
Country

Section 2: Professional Qualifications

Disciplines - select all that apply:
Specialties - select all that apply:
Are you currently registered/licensed with a regulatory oral health profession authority?

Section 3: Program Affiliation

Are you currently affiliated with or working at a CDAC-accredited program, or have you been affiliated within the past three (3) years?

Program Affiliation Details

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Section 4: Skills and Attributes

Please rate yourself on each statement using the following scale: 1 = Strongly Disagree 2 = Disagree 3 = Neutral 4 = Agree 5 = Strongly Agree

Section 5: Accreditation Experience

Do you have prior experience with accreditation processes?

Accreditation Experience Details

0 of 500 max words
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Section 6: Please explain why you are interested in becoming a surveyor

0 of 500 max words

Section 7: Attachments

Maximum file size: 5MB

Maximum file size: 5MB

Maximum file size: 5MB

Maximum file size: 5MB

Applicant Acknowledgements

Section 8: Declaration and Signature

By signing below, I certify that:

The information provided in this application is true and complete.

I understand that misrepresentation may result in disqualification from the CDAC Surveyor pool.

Questions? Contact CDAC at [email protected].