Personal Information
After you complete the online form, you will receive an email with instructions to complete “your profile”. Please check your junk mail folder/ spam filter if you do not receive the email.

If you are unable to complete the profile creation process and require assistance, please contact CDHM at .
Application Type *

First Name *
Middle Name
Last Name *
Gender *
Street Address *
Zip/Postal Code *
Country *
State/Province *
City *
Home Phone *   
Birth Date *
School Country *
If you were not educated in Canada, please contact the college for application instructions.
School State/Province *
School of Graduation *
Have you been registered/licensed/certified to practise as a dental hygienist in any other provinces, states, or countries in the last five (5) years? *
NDHCB Number *
NDHCB Granted Date *
Email *
Confirm Email *

I acknowledge that the personal information provided on this form is used pursuant to the Dental Hygienist Act. The College of Dental Hygienists of Manitoba also has a responsibility to ensure that personal information is safeguarded.