TODAY'S DATE: Nov 14, 2006 - UAB€¦ · Web viewTitle: TODAY'S DATE: Nov 14, 2006 Author: Krish Last modified by: Carey Cauthen Created Date: 3/19/2015 8:35:00 PM Company: Home

TODAY'S DATE: NAME AADSAS ID:

AADSAS Application Worksheet

College Courses Completed This list is organized by the order of Session date.

No. 1 Session Date: College Attended Session Status

Academic Status

Session Term Term Type

Course Title, Prefix, and Number

Course Subject

Course Level Grade AADSAS

Grade Verified Grade Credits Verified Credits

Special Classification

Total number of courses


Academic Status



Course Subject






Academic Status



Course Subject






Academic Status



Course Subject






Academic Status



Course Subject






Academic Status



Course Subject






Academic Status



Course Subject






Academic Status



Course Subject






Academic Status



Course Subject





College Courses Planned or In Progress This list is organized by the order of Session date.

No. 10 Session Date College Attended Session

StatusAcademic Status



Course Subject Course Level Grade AADSAS

GradeVerified Grade Credits Verified Credits Special

Classification


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, ScholarshipsAward/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.):

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 2Relationship 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 ServiceOrganization Position/Title Total Exp. Hrs Avg. Weekly Hrs Start Date End Date Research ExperienceOrganization 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 InformationDescribe 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

Release Statements I certify that I have read the ADEA statement, Ethical Conduct in Applying to Dental Education Programs, and that the information I have provided in this AADSAS application is complete and accurate to the best of my knowledge. I understand that withholding or falsifying information requested in the AADSAS application could result in the suspension of my application and/or other actions, including the possibility of expulsion after enrollment in a school of dentistry.I agree to the terms of this certification statement I give permission for AADSAS to release selected information about the status of my AADSAS application to the chief health professions advisor and the health professions advisory committee of the post-secondary institution(s) I have attended. By releasing this information, advisors are better able to assist applicants in the application process and advise applicants in the future. Applicants cannot make changes to this item after submitting their application to AADSAS.I agree to the terms of this certification statement

https://aadsas.adea.org/aadsas07/PrintApp.cgi?usefuldummy=AAINFHBS7A9T9HJS5A5DB7IBE8AL756IL5B9G6569M5E9F888I8D785LBB678596JBM8E57GBLII8CF7H669989H5J7I7EH9M68E&ptype=1#%23

DAT ScoresU.S. DAT Scores Month: Year: Month: Year: Academic Average: Perceptual Ability: Quantitative Reasoning: Reading Comprehension: Biology: General Chemistry: Organic Chemistry: Total Science: Canadian DAT Scores Month: Year: Month: Year: Reading Comprehension: Biology: Chemistry: Science Total: Academic Average: PAT: Chalk Carving:

EvaluatorsDate Name School/Institution Status Date Received

Dentistry ExperienceName of supervisor Position Title Description Position Type Start Date End Date

Documents

TODAY'S DATE: Nov 14, 2006 - UAB€¦ · Web viewTitle: TODAY'S DATE: Nov 14, 2006 Author: Krish Last modified by: Carey Cauthen Created Date: 3/19/2015 8:35:00 PM Company: Home