Online Application

First Name:

M.I.

Last Name:

Date of Birth:

Sex:

Female

Male

Country of Citizenship:

Street/Address:

Apt./Box #:

City:

State/Province:

Country:

Postal Code:

Telephone:

Email Address:

Permanent Address (if different than above)

Street/Address:

Apt./Box #:

City:

State/Province:

Country:

Postal Code:

Education Record

University:

Degree:

GPA/Class Rank:

Major:

Matriculation Date:

(Expected)
Date of Graduation:

If you have attended more than one institution, please list the most recent above and include the next most recent below:

University:

Degree:

GPA/Class Rank:

Major:

Matriculation Date:

(Expected)
Date of Graduation:

Please have official transcripts sent from your undergraduate institution and your dental school. Indicate here the date you requested the transcripts to be sent:

List at least 2 faculty members who have been asked to write letters of recommendation on your behalf:

Name:

Title:

Telephone:

Name:

Title:

Telephone:

Name:

Title:

Telephone:

Trainees will receive a stipend of approximately $3,400 for the two-month period of training. In addition, housing will be provided by the University of Rochester. Some dental schools provide travel assistance for students in this program. If such aid is unavailable or insufficient, some assistance for travel costs may be available for applicants who can demonstrate clear financial need. To apply for travel assistance, please have the financial aid officer of your dental school send a letter in support of your request, documenting your need.

Indicate whether or not you will request financial assistance:

Yes

No

The Program will run from approximately June 1 through August 1. Please indicate any time during this period that you would be unable to participate (for example, due to National Boards, family obligations, etc.):

Personal Statement

Please answer the following questions. Since we are unable to interview candidates, your answers play a large role in our decisions.

Why do you wish to participate in this program?

If you have participated in research-related acitivites, please describe them:

What are your scientific research interests?

What are your career goals?

How will this experience assist you in reaching your long-term career goals?

What do you consider to be your greatest personal strength? Weakness? Why?

For U.S. citizens and permanent residents only.
How would you describe yourself? (Please check one).

African American

American Indian or Alaskan Native

Asian or Pacific Islander
(including Indian subcontinent)