University of Colorado School of Dental Medicine

Application for Geriatric Dental Medicine Fellowship

  • Please include copied of university degrees and certificates with your application. We also require a transcript of your dental education. If your institution does not provide official transcripts, please include a statement to that effect from your institution, and then attach notarized copies of your transcripts with the statement "I certify these are faithful copies of the original transcripts". Official transcripts may be mailed directly to us from the institution's Registrar's Office.
  • We require that all foreign dental school transcripts be sent to one of the credentialing agencies in the United States for evaluation; as for a course-by-course evaluation. We also ask that the credentialing agency send their report directly to our office. We will not accept credentialing reports from applicant.
  • We require a $50 application fee with receipt of your application. Please provide a check made payable to the Regents of the University of Colorado. In the memo line, please add "Geriatric Dental Medicine Application Fee".
  • If you have any questions regarding the fellowship or completing this application, please contact Amy Schmidt at amy.s.schmidt@cuanschutz.edu

I. General Information

Is your current adress outside the United States?*
Is your Permanent Address different than your Current Address?*
Is your permanent address outside the United States?*

If outside the US, please provide City/State or City/Province

Please select the correct Country Code

Phone

II. Education Background

City/State OR Country

No Abbreviations

City/State OR Country

No Abbreviations

Do you have a Masters Degree?*

City/State OR Country

Please add specialization such as MBA, Masters of Science, etc.

Do you have an additional Graduate Degree?*

Not including Fellowship or Residency

City/State OR Country

Please add specialization such as MBA, Masters of Science, etc.

Did you complete a Residency or Fellowship?*

City/State OR Country

Please specify the type of Residency of Fellowship (Pediatrics, OMFS, etc)


III. Personal Statement

In 500 words or less describe why you are interested in Special Care Dentistry, specifically in the area of Geriatric Dentistry, what you hope to learn, and what you hope to do with the knowledge and experiences gained.

Please highlight any life experiences, skills, aptitudes, and post graduate education that you believe make you a good candidate for this Fellowship.


IV. References/Recommendations

Please provide the name, phone number and email addresses of two people familiar with your experience and abilities, who will be willing to write a letter of recommendation on your behalf. If you are currently employed or enrolled in an educational program, one of your references must be your current supervisor or primary mentor.

Phone
Phone

V. CV/Resume and Other Documents

Please attach a short resume/CV as part of your application that includes the following:


  1. A statement describing your primary objective
  2. List of any professional licenses and/or registrations, including initial date granted and current expiration.
  3. Chronologically lists any relevant work experience, employment title, employment duties and responsibilities, and employer and dates employed.
  4. Lists any relevant memberships, offices or appointments held, and dates of participation.
  5. Lists major awards and honors received, including dates of recognition.
  6. Describes participation in any service activities and/or community health volunteerism.

Please attach any relevant and required documents

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