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Personal Statement (Essay)



Your Personal Statement should address why you desire to pursue a dental education and how a dental degree contributes to your personal and professional goals.

You are encouraged to compose your statement in a text-only word processor (e.g., Notepad), review your statement for errors, then cut and paste the final version into the text box above. Click the Save button and return to the Personal Statement to review the formatting of your text. You are limited to approximately 1 page (4500 characters, including spaces).

Some formatting characters used in programs like Word (angled quotes, accents, special characters) will not display properly. Carefully review your final text and to make the necessary corrections to the format.

     


Awards, Honors, Scholarships

Award/Honor/Scholarship

Sponsoring organization

Date Received or Awarded

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     


Biographic Information

Preferred Address

Street, Line 1:

     

Street, Line 2:

     

City:

     

State/Province:

     

Country:

     

Zip Code:

     

County:

     

Telephone:

     

Cell Number:

     

Fax Number:

     

Telephone Country Code (non-U.S.):

     

Telephone City Code (non-U.S.):

     

E-mail:

     


Permanent Address

Click here if this information is the same as Preferred Address:

     

Street, Line 1:

     

Street, Line 2:

     

City:

     

State/Province:

     

Country:

     

Zip Code:

     

County:

     

Telephone:

     

Telephone Country Code (non-U.S.):

     

Telephone City Code (non-U.S.):

     




     

Personal Information

Gender:

     

Ethnic Identification:

     

U.S. Visa Status:

     

U.S. Visa Number:

     

City of Visa Issue:

     

Country of Visa Issue:

     


Parent and Family Information
Parent 1

Relationship to Applicant:

     

Indicate if parent is living:

     

Title:

     

First Name:

     

Last Name:

     

Middle Initial:

     

Street, Line 1:

     

Street, Line 2:

     

City:

     

State/Province:

     

Country:

     

Zip Code:

     

Telephone:

     

Telephone Country Code:

     

Telephone City Code:

     

Occupation:

     

Education:


     

Parent 2

Relationship to Applicant:

     

Indicate if parent is living:

     

Title:

     

First Name:

     

Last Name:

     

Middle Initial:

     

Street, Line 1:

     

Street, Line 2:

     

City:

     

State/Province:

     

Country:

     

Zip Code:

     

Telephone:

     

Telephone Country Code:

     

Telephone City Code:

     

Occupation:

     

Education:

     


Extracurricular/Volunteer/Community Service

Organization

Position/Title

Total Exp. Hrs

Avg. Weekly Hrs

Start Date

End Date

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     


Research Experience

Organization

Position/Title

Total Exp. Hrs

Avg. Weekly Hrs

Start Date

End Date

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     


Colleges Attended

College

From

To

Degree

Degree Status

Date Degree Earned or Anticipated

Major for Degree

2nd Major

2nd Degree

2nd Degree Status

Date 2nd Degree Earned or

Anticipated



Major for 2nd Degree

2nd Major for 2nd Degree

Dental Certificate Earned

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     


Background Information

Describe any activities requiring manual dexterity (e.g. activities requiring hand-eye coordination such as cross-stitching, sewing, art, crafts, playing musical instruments, auto repair, etc.) at which you are proficient.

     

Do you have any relatives who are dentists, are in dental school, or who have studied or are studying Dental Hygiene, Dental Assisting, Dental Laboratory Technology or related dental fields?

     

If yes, indicate name, relationship, name of school, dental degree or certificate, year of graduation or expected graduation:

     

List any supplemental academic enrichment programs and/or post-baccalaureate programs in which you have participated to enhance your preparation for dental school.
You may list programs experienced in high school and/or college that may include (but are not limited to): summer academic enrichment programs targeted to disadvantaged students; DAT preparation courses offered by an academic institution or commercial entity, and post-baccalaureate programs.


Provide the name of the program, a brief description, and total hours of participation, and dates of experience(s).

     

Have you ever been dismissed, disqualified, suspended, put on probation, or otherwise been subject to disciplinary action at any college or university in connection with your academic performance?

     

If you answered “yes” to the previous question, enter an explanation here regarding each such disciplinary action. Include 1) a brief description of the incident that was the basis for the disciplinary action, 2) the specific charge(s) made, 3) the disciplinary action taken, and 4) a reflection on the experience and how the experience has affected your life.

     

Have you ever been dismissed, expelled, found to have violated an honor code, disqualified, suspended, put on probation, or otherwise been subject to disciplinary action at any college/university in connection to misconduct?

     

If you answered “yes”, enter an explanation here regarding each violation. Include 1) a brief description of the incident, 2) the specific charge(s) made, 3) the disciplinary action taken, and 4) a reflection on the experience and how the experience has affected your life.

     

Have you ever applied to dental school prior to the present application cycle?

     

If yes, include the name of schools to which you applied and year(s) of application. If accepted/enrolled, indicate dates of enrollment:

     

Have you previously, or are you currently applying to a health profession school other than dental school?

     

If yes, indicate school(s), type of program, year applied, and also indicate if you were accepted and/or enrolled.

     

Has your education ever been interrupted or affected adversely for reasons other than deficiencies in conduct or academic performance?

     

If yes, please describe.

     


Work Experience (including Military Service)

Employer

Position Title/Brief Desc

Avg. Weekly Hrs

Start Date

End Date

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

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