Adams School of Dentistry

First Name/ Preferred Name:*

Last Name: *

Email Address: *

Your Contact Phone Number: *

Name of your most recent Educational Institution. *

What is your Academic Status? *
1st Year
Sophomore
Junior
Senior
Grad
Post-bac
Other

Which of the following best represents your current highest level of education (beyond high school)? *
Undergraduate
Associates degree (completed)
Bachelor's degree (completed)
Postgraduate Studies (e.g. Master's, Ph.D.)
Other

To ensure we are well-prepared for the presentation, please feel free to submit any questions that you may have concerning admissions, residencies, private practice curriculum, culture... here:

Anticipated Application Cycle:*
When do you anticipate submitting your first dental school application?
2026 - 2027 cycle
2027 - 2028 cycle
2028 - 2029 cycle
Later
Undecided

Prerequisite Coursework Progress:*
Which of the folowing prerequisite science courses have you completed or are currently enrolled in? (Select all that apply)
General Biology
Lab
Anatomy & Physiology
Lab
General/Inorganic Chemistry I
Lab
General/Inorganic Chemistry II
Lab
Organic Chemistry I
Organic Chemistry II
Physics I
Physics II
Biochemistry
English
None yet
Other

Perceptual Ability:*
What ativities have you been involved in to demonstrate your Perceptual Ability?

Ability to Fully Participate:*
If selected, are you able to commit to full participation for the entire duration of the event (8:00 a.m. - 4:30 p.m.)?
Yes
No
Unsure

Role & Readiness:*
If preparing for dental school were like being on the television show Survivor, how would you describe your role right now - learning the environment, building skills, contributing to the team, leading strategy, or something else? What makes you say that? (Maximum length: 2000 characters.)

Emergency Contact Name: *

Emergency Contact Phone No.: *

Please indicate whether you plan to attend the event in person or participate in the virtual component.*

Note: Virtual component remains free; registration fees ($40) apply for in-person attendees(lunch included).
In-Person Programming
Virtual Programming

Registration Fee (Non Refundable): $

Name on Credit Card:*

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Bridge to Dentistry: Prepared for Purpose

Registration Information

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