Gateway to Dentistry Externships Application - Part 1

Please Fill In The Appropriate Information To Apply Online.
All Fields Are Required To Be Filled In,
Otherwise Application Will Not Be Processed.
When Finished Please Click The Submit Application Button.

Applicant:

School:

Present Major:

Present Enrollment:

Year Graduated: (Optional)
School Address:

School Phone #:

School e-mail:
(Personal School e-mail)

Home Address:

Home Phone #:

Home e-mail:

Contact Person and Phone Number (in case of emergency; ie: Mom, Dad):

Contact Relationship:

Gender:*
Ethnicity:*
We Do Not Provide Housing, Do You Need Hotel Information?

YES NO
Which Session Would You Prefer?
Enclose a one-time non-refundable application fee of $20.00 (money order or check). If payment of the application fee would pose a financial hardship NJDS will consider waiving the fee on a case by case basis, pending receipt of documentation.

May 27, 2008 - June 6, 2008 (Closed)

January 6, 2009 - January 16, 2009 (Deadline: 09/25/08)

May 27, 2009 - June 5, 2009 (Deadline: 02/26/09)

Have You Applied To Any Dental School?
YES NO
What is Your Anticipated Start Date for Dental School?
How many hours and what type of shadowing or dental experience have you had?
(Please state answer in one or two sentences)
What is your primary goal in completing the Gateway to Dentistry Program?
(Please state answer in one or two sentences)

*Responding to these questions is optional and will not affect your chances of being admitted.

NO APPLICATION WILL BE ACCEPTED WITHOUT A LETTER OF RECOMMENDATION FROM YOUR PRE-HEALTH ADVISOR

Enclose a one-time non-refundable application fee of $20.00 (money order or check). If payment of the application fee would pose a financial hardship NJDS will consider waiving the fee on a case by case basis, pending receipt of documentation.

Forward To:
Dr. Kim Fenesy
UMDNJ-New Jersey Dental School
Office of Student Affairs - B829
110 Bergen Street
Newark, NJ 07103