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If you are interested in being considered for the DDS/PhD program at the Dental School, University of Maryland, Baltimore, we would appreciate your completing the following form. This will help us to identify which members of our faculty that you might be interested in speaking with during your interview. For more information about our program please visit our DDS/PhD site.

Answer as many of the questions below as you like and feel free to ask us any questions in return. Required fields are marked in bold.

Thanks for your interest!

Name

FIRST
  
MIDDLE
  
LAST
Current Contact Information
Street Address Line 1
Street Address Line 2
City / State / Zip                       
Country
Phone Number
Email
Educational Background
Are you currently enrolled in school? Yes
No
Current or most recent school?
What is your major area of study?
What and when was your last degree?    (year)
Test scores
Date of DAT Examination
DAT Scores Reading Comprehension
Quantitative Reasoning
Survey of Natural Science
Perceptual Ability
Average Score
Have you taken the Graduate Record Exam?
*Not required for DDS/PhD		 Yes
No
GRE Scores Verbal
Quantitative
Analytical
Subject test (if available)
Specify subject for above score
Have you taken the TOEFL Exam (if applicable)? Yes
No
TOEFL Score
 Closing Questions
If you are interested in any particular research area, please describe it in a few words.
Semester and year for which you wish to apply 20
If you have any specific requests or questions, please let us know here.