State of Residency: Sex: Male Female Place of Birth: Date of Birth (MM/DD/YYYY): / / Type of Visa (if applicable):

Transcription

1 Texas A&M University College of Dentistry Graduate Application for Admission Use this application if you are not applying through PASS. You do not need to do both. Type or print in ink. Check where appropriate. Full Legal Name: (Last Name) (First Name) (Middle Name) Other names under which academic work pursued: Social Security Number: DENTPIN: Term of anticipated first registration: address checked regularly: Present Address: Permanent Address: Home Phone: Cell Phone: State of Residency: Sex: Male Female Place of Birth: Date of Birth (MM/DD/YYYY): / / Citizenship: Type of Visa (if applicable): Program for which you are applying: Have you previously applied to this particular program? Yes No If yes, when? Have you ever attended Texas A&M College of Dentistry? Yes No If yes, when? List all colleges or universities attended, beginning with the most recent. Name of Institution Location of Institution Month/Year of Attendance Major Degree/Hours to to to to National Board Dental Examination (NBDE) Not required for applicants with a foreign dental degree. When applicable, have the testing agnecy submit NBDE scores directly to the College of Dentistry at nbde@tamhsc.edu. Part 1 submitted? Yes No N/A Part 2 submitted? Yes No N/A Advanced Dental Admissions Test (ADAT) For applicants with a US dental degree, in some instances, an ADAT test score can be provided in lieu of GRE. Not all programs accept ADAT in lieu of GRE. Contact your program of choice to be sure before submitting scores. When applicable, you must submit GRE or ADAT scores. Scores should be sent directly to the College of Dentistry from the testing agency. Test taken? Yes No When? Scores submitted? Yes No When? Graduate Record Exam (GRE) Not all programs require a GRE score. Contact your program of choice to be sure before submitting scores. Some programs will accept ADAT in lieu of GRE. Contact your program of choice to be sure before submitting scores. When required, GRE scores should be sent directly from the Educational Testing Service to Texas A&M University and be from a test date within five years of the date the application reaches the College. Use code 6003 for reporting GRE scores. A department code is not needed. Test taken? Yes No When? Scores submitted? Yes No When?

2 English Language Skills Testing Applicants from non-english-speaking countries must have their English skills evaluated by scoring a minimum of 550 on the paper TOEFL test, 80 on the internet TOEFL test, 6.0 on the IELTS, or 53 on the PTE. This requirement may be waived if a degree has been awarded in the US. You must request that scores be sent directly to Texas A&M University (Code 6003) from the testing agency. Test taken and scores submitted? Yes No N/A Are you requesting a waiver? Yes No N/A Narrative and Curriculum Vitae On a separate page, outline your academic interests and goals and then relate them to your career goals. Include any current or long-range participation in research, teaching, or other professional objectives. If you have progressed far enough in your career to have publications or other evidence of scholarly or creative endeavors, describe these as well. Be sure to include any academic or professional organizations, fellowships, scholarships, or other honors. References / Request for Information Ask three people who know your academic qualifications well to write a recommendation on your behalf. Use the included Request for Information Form. List their names, positions, and addresses below. If you are filling this form out by hand, be sure to fill out the information at the top of each form and provide the respondent with a stamped, addressed envelope. These should be sent directly to the Office of Student Affairs; Texas A&M College of Dentistry; 3302 Gaston Avenue; Dallas, Texas Name Position Address Official Transcripts and Dean s Letter Official transcripts from all colleges and universities you attended (even if no degree earned) should be sent directly to the College of Dentistry. A letter from the Dean of the dental school from which you graduated should be sent as well. The letter should certify your GPA and class rank. Have them sent directly to the Office of Student Affairs; Texas A&M College of Dentistry; 3302 Gaston Avenue; Dallas, Texas All foreign transcripts must be evaluated by Education Credentials Evaluators (ECE). Request the course-by-course report. Statement of Waiver of Rights In compliance with Public Law , Family Educational Rights and Privacy Act of 1974, the following statement is provided for your use in case you desire to exercise the option. I hereby voluntarily waive my right of access to any materials used for evaluation of my application for admission to the College of Dentistry, provided such materials are restricted to or limited to letters of recommendation and/or forms used by the College, on which comments are made and submitted as a part of the evaluation process. Yes No Applicant s Signature The following items are required in order to complete your Graduate Application. Mail the first four items listed below to the Office of Student Affairs; Texas A&M College of Dentistry; 3302 Gaston Avenue; Dallas, Texas Application Form. Application Fee. $35 for first-time applicants. $25 re-application fee. Make checks payable to Texas A&M College of Dentistry. Narrative and Curriculum Vitae or Resume (see above for details on what to include in the Narrative). NBDE I/II (if applicable). Have them ed to nbde@tamhsc.edu. Official Transcripts (sent directly to the College of Dentistry from all colleges you attended, even if no degree earned). ECE course-by-course evaluation for all foreign transcripts (sent directly to the College of Dentistry by ECE). References (sent directly to the College of Dentistry from Recommender). GRE or ADAT scores (sent directly to the College of Dentistry from the testing agency, if applicable). English language testing scores (sent directly to the College of Dentistry from the testing agency, if applicable). A personal interview may be required, at the discretion of the Program Director. He/She will contact you if this is necessary. I hereby certify that the information given by me on this application is complete and accurate. Applicant s Signature

3 Texas A&M College of Dentistry Statistical Questionnaire Return this form separately from your Graduate Application for Admission. All applicants for admission will be considered without regard to race, color, gender, sexual orientation, creed, age, national origin, or disability. This form will not be placed in your file. The information will be entered into the admissions database. The faculty and staff reviewing your application file will not have access to this information. Your response to the item requesting race or ethnic group is voluntary. The information on this questionnaire is for statistical purposes only and has no bearing on the admissions process. Applicant s Name: Applicant s DENTPIN: Race or ethnic group: Alaskan Native American Indian Asian Black, Non-Hispanic Hispanic White, Non-Hispanic Return this form separately from your Graduate Application for Admission. Print your full name on the outside of the envelope. Send this form directly to: Office of Student Affairs Texas A&M College of Dentistry 3302 Gaston Avenue Dallas, Texas 75246

4 Texas A&M University College of Dentistry Request for Information Recommender, return this form to the College of Dentistry, in the envelope provided. This section should be completed by the Applicant. After filling out this section, print out the three forms and mail each recommender a hard copy of this form. Don t forget to include an addressed, stamped envelope with each form. The address is at the bottom of this page. Applicant s Name: Applicant s DENTPIN: Applicant s Program to which they are applying: Recommender s Name: I have read the Statement of Waiver of Rights on the Graduate Application for Admission and have chosen to waive not to waive my rights of access to this letter. Applicant s Signature This section should be completed by the Recommender. Knowledge of the Applicant How long have you known the Applicant? Years: Months: How well do you know the Applicant? Casually Well Very Well What was the nature of your contact with the Applicant? (Check all that apply.) As a laboratory assistant or grader As a student in one class As a student in more than one class As an employee As an advisee As a student engaged in research under my direction As a student engaged in independent study under my direction Qualifications of the Applicant What is the educational group to which the Applicant is being compared? College seniors First-year graduate students Is the Applicant s scholastic record, as you know it, an accurate index of his/her scholastic potential? Yes No If your answer is no, briefly explain.

5 What is the Applicant s promise as a graduate student? Below Above Good Unusual Outstanding Truly Exceptional Skill Observed Lowest 40% Middle 20% Next 15% Next 15% Highest 10% Research Skills Clinical Skills Persistence Ability to work with others Ability to work independently Ability to organize thoughts Speaking Skills Writing Skills Do you have any information related to the character, temperament, physical/mental health of the Applicant that should be considered by Admissions in planning the Applicant s graduate work? Yes No If your answer is yes, briefly explain. Additional written comments and/or a letter of recommendation are highly desirable. I hereby certify that the information given by me on this recommendation is complete and accurate. Recommender s Signature No stamped, addressed envelope provided? Send this form directly to: Office of Student Affairs Texas A&M College of Dentistry 3302 Gaston Avenue Dallas, Texas 75246

6 Texas A&M University College of Dentistry Request for Information Recommender, return this form to the College of Dentistry, in the envelope provided. This section should be completed by the Applicant. After filling out this section, print out the three forms and mail each recommender a hard copy of this form. Don t forget to include an addressed, stamped envelope with each form. The address is at the bottom of this page. Applicant s Name: Applicant s DENTPIN: Applicant s Program to which they are applying: Recommender s Name: I have read the Statement of Waiver of Rights on the Graduate Application for Admission and have chosen to waive not to waive my rights of access to this letter. Applicant s Signature This section should be completed by the Recommender. Knowledge of the Applicant How long have you known the Applicant? Years: Months: How well do you know the Applicant? Casually Well Very Well What was the nature of your contact with the Applicant? (Check all that apply.) As a laboratory assistant or grader As a student in one class As a student in more than one class As an employee As an advisee As a student engaged in research under my direction As a student engaged in independent study under my direction Qualifications of the Applicant What is the educational group to which the Applicant is being compared? College seniors First-year graduate students Is the Applicant s scholastic record, as you know it, an accurate index of his/her scholastic potential? Yes No If your answer is no, briefly explain.

7 What is the Applicant s promise as a graduate student? Below Above Good Unusual Outstanding Truly Exceptional Skill Observed Lowest 40% Middle 20% Next 15% Next 15% Highest 10% Research Skills Clinical Skills Persistence Ability to work with others Ability to work independently Ability to organize thoughts Speaking Skills Writing Skills Do you have any information related to the character, temperament, physical/mental health of the Applicant that should be considered by Admissions in planning the Applicant s graduate work? Yes No If your answer is yes, briefly explain. Additional written comments and/or a letter of recommendation are highly desirable. I hereby certify that the information given by me on this recommendation is complete and accurate. Recommender s Signature No stamped, addressed envelope provided? Send this form directly to: Office of Student Affairs Texas A&M College of Dentistry 3302 Gaston Avenue Dallas, Texas 75246

8 Texas A&M University College of Dentistry Request for Information Recommender, return this form to the College of Dentistry, in the envelope provided. This section should be completed by the Applicant. After filling out this section, print out the three forms and mail each recommender a hard copy of this form. Don t forget to include an addressed, stamped envelope with each form. The address is at the bottom of this page. Applicant s Name: Applicant s DENTPIN: Applicant s Program to which they are applying: Recommender s Name: I have read the Statement of Waiver of Rights on the Graduate Application for Admission and have chosen to waive not to waive my rights of access to this letter. Applicant s Signature This section should be completed by the Recommender. Knowledge of the Applicant How long have you known the Applicant? Years: Months: How well do you know the Applicant? Casually Well Very Well What was the nature of your contact with the Applicant? (Check all that apply.) As a laboratory assistant or grader As a student in one class As a student in more than one class As an employee As an advisee As a student engaged in research under my direction As a student engaged in independent study under my direction Qualifications of the Applicant What is the educational group to which the Applicant is being compared? College seniors First-year graduate students Is the Applicant s scholastic record, as you know it, an accurate index of his/her scholastic potential? Yes No If your answer is no, briefly explain.

9 What is the Applicant s promise as a graduate student? Below Above Good Unusual Outstanding Truly Exceptional Skill Observed Lowest 40% Middle 20% Next 15% Next 15% Highest 10% Research Skills Clinical Skills Persistence Ability to work with others Ability to work independently Ability to organize thoughts Speaking Skills Writing Skills Do you have any information related to the character, temperament, physical/mental health of the Applicant that should be considered by Admissions in planning the Applicant s graduate work? Yes No If your answer is yes, briefly explain. Additional written comments and/or a letter of recommendation are highly desirable. I hereby certify that the information given by me on this recommendation is complete and accurate. Recommender s Signature No stamped, addressed envelope provided? Send this form directly to: Office of Student Affairs Texas A&M College of Dentistry 3302 Gaston Avenue Dallas, Texas 75246