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Submission Checklist

Print out this checklist to use as a reference when submitting your CE. For questions, please contact 888.243.3368 or membership@agd.org.

• Name and Address: Please be sure your name is clear and legible on all CE course verification forms.
• AGD Membership Number: Always include your six-digit AGD membership number.
• CE Program Provider Name and/or AGD PACE Provider Number: This information must be included to accurately receive AGD PACE or American Dental Association CERP-approved credits toward the FAGD or MAGD awards. Print the complete name of the organization providing the course.  DO NOT USE ABBREVIATIONS.  Include the six-digit provider code number, if available.
• Course Date: Please include the complete month, day, and year the course was given.  If it lasted more than one day, give both the beginning and ending dates of the course.
• Subject Code:  AGD subject codes correspond to various topics in dentistry. Obtain a subject code list.
• Title of Course and Instructor Name: Include the title of the course and full name of the instructor.
• Hours:  The actual number of clock hours spent in the course.  Do not include time for lunch or registration.  Indicate if the course is ‘Lecture’, ‘Participation’ or ‘Self-Instruction’.
1. Participation courses must have a hands-on component that equals at least 30 percent of the course content.
2. Self-Instructional courses:  If the course was self-instructional, you must provide a copy of your certificate of course completion or other proof of attendance from the program provider.  
• Course Location, Please include the city and/state where the course took place.
• Credit for teaching, published articles or textbooks, formal post-graduate/residency programs:  Submission of these types of CE must be in letter form. Verification of the activity must be included.