Are you interested in dentistry? Would you like to shadow a dentist? If
so, use the application below to be paired with a mentor, to learn more
about the dental profession.
STUDENT SHADOW APPLICATION
* Required Field
Subject:
Your name:
*
Email:
*
*
Address:
City:
*
*
 State:
*
 Zip Code:
*
 Phone:
*
 Fax:
Your School and Year in School:
What is your hometown?
What are your hobbies?
What are your goals?
How did you become interested in dentistry?
Are you interested in a special field of dentistry?
Are you interested in private practice, hospital dentistry or teaching
dentistry?
What do you expect to gain from this program?
How much time will you be available to shadow a dentist?