Dental Examination Forms
The following material contains those forms used by CITA in the administration of its licensure examinations. These forms are being provided to assist candidates who might wish to become familiar with their content and usage. These forms are also provided to candidates, on an as needed basis, during the various stages of CITA’s application and examination process. These forms are for information purposes only and the forms downloaded from this site are NOT for candidates to bring and use during the examination, with the exception of the Treatment Selection Worksheet and Radiograph/Follow Up Care Forms.
In order to view and/or download the forms, Adobe Acrobat Reader is required.
2013 Application Forms
Junior Certification Form
Senior Certification Form
Dental School Codes
Dental Facility Fees
2013 Miscellaneous Examination Forms
Certification of Examination Preparation and Orientation Form
Dental Assisting Form
Interpreter Form
Limitation of Liability Form
Special Accommodations Form
Example of Patient-Based Examination Schedule
Example of Manikin-Based Examination Schedule
Review and Appeals Application
2013 Test Site Facility Information
LSU School of Dentistry (updated 04-11-13)
University of Alabama School of Dentistry
UNC School of Dentistry FEBRUARY examination
UNC School of Dentistry APRIL examination
UPR School of Dentistry
2013 Periodontal Examination Forms and Grade Sheets
Periodontal Examination Forms and Material Tutorial Packet
Periodontal Progress Form
Oral Assessment Form
Treatment Selection Worksheet
Treatment Selection Evaluation Form
Treatment Evaluation Form
Treatment Selection Grading Room Request Form
Treatment Evaluation Grading Room Request Form
Instructions to Candidate Form
Radiograph/Follow Up Care Form
2013 Restorative Examination Forms and Grade Sheets
Restorative Examination Forms and Material Tutorial Packet
Class II Progress Form
Class II Preparation Grading Room Request Form
Class II Restoration Grading Room Request Form
Class II Radiograph/Follow Up Care Form
Class II (Preparation and Restoration) Grade Sheets (Updated 12-04-12)
Class III Progress Form
Class III Preparation Grading Room Request Form
Class III Restoration Grading Room Request Form
Class III Radiograph/Follow Up Care Form
Class III(Preparation and Restoration) Grade Sheets (Updated 10-31-12)
Modification Request Form
Instructions to Candidate
Exposure Processing Form
2013 Manikin Examination Forms and Grade Sheets 
Endodontic Progress Form
Endodontic Grade Sheets
Prosthodontic Progress Form (Updated 12-06-12)
Prosthodontic Grade Sheets (Updated 12-04-12)