UCSF Fellowship in Craniofacial and Special Care Orthodontics Application

UCSF Fellowship in Craniofacial and Special Care Orthodontics Application

Complete all sections of the application then scan and upload supporting documentation:

1. Personal Statement of Purpose: Please include your goals of completing this training and plans after completion of the fellowship. Also provide your interests in craniofacial research.

2. Curriculum Vitae

3. Official copy of transcript(s) from all colleges/universities attended.

4. Official copy of transcript(s) from foreign universities and Canadian institutions where English was not the official language of instruction (if applicable).

5. Official copy of course-by-course evaluation from ECE or WES for ALL foreign transcripts received outside of the US including Canadian schools where English was not the official language of instruction.

6. Official TOEFL (Test of English as a Foreign Language) scores. Test is required for those applicants whose native language is not English and have not attended a US institution for at least one year.

A waiver request may be submitted as part of your application. You may request a waiver if your degree (minimum two years' duration) was conducted exclusively in English, or you have lived or worked in an English-speaking country for at least two years since graduation. Click here for the form.

7. Three letters of recommendation; at least two letters should be from faculty in the applicant’s orthodontics program.

8. Non-refundable application fee of $250 USD (Click here to pay online). Please note: Applicants will be considered only after this application and all other items are received by UCSF School of Dentistry, Office of Continuing Dental Education.

Today's Date*

First Name*

Middle Name

Surname*

Telephone:*

(Country/Area Code) Number

Home Address:*

Street, City, State, Mail Code

US Address:*

Street, City, State, Mail Code

Email Address:*

Date of Birth:*

Place of Birth:*

Marital Status:*

Number of Children:*

I have/I am a:*

International preceptors who require visa sponsorship will be supported on the J-1 Student-Non Degree visa. For information on the J-1 Student Non-Degree visa, visit the UCSF International Student and Scholars Office website or email visa@ucsf.edu.

If you live in the United States, what current VISA do you have?*

Enter N/A if not applicable.

Current US Visa Status-Passport #:*

Enter N/A if not applicable.

Language(s) Spoken:*

Education

Institution - Dates Attended (From | To) - Major & Minor Fields - Degree & Date*

List colleges, universities, graduate and professional schools at which credit have been earned.

Orthodontic Residency

Institution*

Dates Attended*

Number of Patients Treated*

Completion Date*

Experience

Teaching*

Please describe nature of work and dates attended. If this doesn't apply, please enter N/A.

Private Practice*

Please describe nature of work and dates attended. If this doesn't apply, please enter N/A.

Research*

Please describe nature of work and dates attended. If this doesn't apply, please enter N/A.

Military Service*

Please describe nature of work and dates attended. If this doesn't apply, please enter N/A.

Other

Are you currently a full-time/part-time faculty or part of a craniofacial team?*

Yes

If yes, which craniofacial team or university?

Please share your interests outside of Orthodontics.*

File(s) Upload*

Please refer to the top of the application and upload all required documents.

Drag and drop files here or

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