Not Taken SRTA Letter Request

Candidates can apply below for a non-failure verification letter that you have not taken a SRTA administered examination.

• Personal Information

• Name*
  First Last
• Last 4 digits of SSN*
• Date of Birth*
  Please input numbers only, no special characters or punctuations permitted.
• Phone*
• Candidate's Email*
• State Board Email*
  Authorized .org/.gov contact email address for the candidate’s application with the Louisiana State Dental Board

• Fee Information

• Letter Fee
  Price:
• Total
  $0.00
• Payment Information*
  American Express

  Discover

  MasterCard

  Visa

  Supported Credit Cards: American Express, Discover, MasterCard, Visa

  Card Number Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date   Security Code Cardholder Name
• Phone
  This field is for validation purposes and should be left unchanged.

Hit the 'Submit' button 1 time only.