RSDM Gateway to Dentistry Externships Application

RSDM Gateway to Dentistry Externships Application

Please fill in the appropriate information to apply online.

All fields except those marked optional are required to be filled in, otherwise the application will not be processed.

When finished please click the submit button to submit the application.

No application will be accepted without a letter of recommendation, transcripts, and/or $75.00 application fee.

Application fees via credit card:

https://go.rutgers.edu/rsdm-fee-gateway-application

Application fees via check should be made payable to RSDM and forwarded to:

Maritza Camacho

Rutgers School of Dental Medicine

Office of Student Affairs

110 Bergen Street, B830

Newark, NJ 07103

Applicant Full Name*

Date of Birth (MM/DD/YYYY)*

Gender*

Ethnicity*

Academic Experience

School*

Present Enrollment*

Select or enter value

Year Graduated

School Address*

School Phone #*

Phone

Personal School Email*

Contact Information

Home Address*

Home Phone #*

Phone

Personal Email*

Emergency Contact

Emergency Contact*

Emergency Contact Relationship*

Emergency Contact Phone #*

Phone

Accomodations

We do not provide housing, will you need a hotel?*

Select or enter value

Session Information

Which session would you prefer?*

Monday, January 6, 2025 - Friday, January 10, 2025

Monday, June 2, 2025 - Friday, June 6, 2025

Have you previously applied to the Gateway or SMDEP Program?*

Yes

Have you applied to dental school?*

Yes

Dental School Applicants - DO NOT SUBMIT

Application to the Dental Program will automatically disqualify you for acceptance into the Gateway Program, since this program has been designed for students who are thinking of dentistry as a career choice. Please do not submit this application.

Experience

Shadowing or Dental Experience*

State below how many hours and what type of shadowing or dental experience you have had.

Please state answer in one or two sentences.

Primary goal in completing the Gateway to Dentistry Program*

State below what is your primary goal in completing the Gateway to Dentistry Program.

Please state answer in one or two sentences.

Disclaimer

By submitting my application:

I certify that I am not a current or previous applicant to any dental school.

I understand that my participation in this program no way obligates RSDM to guarantee acceptance into the dental program.

I understand that my application will not be considered for the program unless the application fee, recommendation letter, and transcripts are received by the deadline.

Send me a copy of my responses

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