2024 AGD Fall Fellowship Scholarship Application Form Scholarship details: Applicants must be AGD new dentist members who graduated between 2019-2024. This scholarship will cover the Fellowship review course fee, exam fee, airfare, and hotel for recipients. Awardees can take the exam on Oct. 6 or at a testing center near their home by Dec. 31, 2024. Applications close on June 3, 2024. For additional details on AGD's Fellowship Award, visit our FAGD webpage. OK Question Title * 1. Name: OK Question Title * 2. Email: OK Question Title * 3. AGD member ID: OK Question Title * 4. City of residence: OK Question Title * 5. Your constituent: Air Force AGD Alabama AGD Alaska AGD Alberta AGD Arizona AGD Arkansas AGD Army AGD Atlantic Provinces AGD British Columbia AGD California AGD Civil Service AGD Colorado AGD Connecticut AGD Delaware AGD District of Columbia AGD Florida AGD Georgia AGD Hawaii AGD Idaho AGD Illinois AGD Indiana AGD International AGD Iowa AGD Kansas AGD Kentucky AGD Louisiana AGD Maine AGD Manitoba AGD Maryland AGD Massachusetts AGD Michigan AGD Minnesota AGD Mississippi AGD Missouri AGD Montana AGD Navy AGD Nebraska AGD Nevada AGD New Hampshire AGD New Jersey AGD New Mexico AGD New York AGD North Carolina AGD North Dakota AGD Northwest Territories AGD Ohio AGD Oklahoma AGD Ontario AGD Oregon AGD Peace Corps AGD Pennsylvania AGD Public Health AGD Puerto Rico AGD Quebec AGD Rhode Island AGD Saskatchewan AGD South Carolina AGD South Dakota AGD Tennessee AGD Texas AGD Utah AGD Vermont AGD Veterans Admin AGD Virgin Islands AGD Virginia AGD Washington AGD West Virginia AGD Wisconsin AGD Wyoming AGD Other OK Question Title * 6. What dental school did you graduate from? A.T. Still University Arizona School of Dentistry & Oral Health A.T. Still University Missouri School of Dentistry & Oral Health Augusta University Dental College of Georgia Boston University Henry M. Goldman School of Dental Medicine California Northstate University, College of Dental Medicine Case Western Reserve University School of Dental Medicine Columbia University College of Dental Medicine Creighton University School of Dentistry Dalhousie University Faculty of Dentistry East Carolina University School of Dental Medicine Harvard University School of Dental Medicine Howard University College of Dentistry Indiana University School of Dentistry Kansas City University College of Dental Medicine LECOM College of Dental Medicine Lincoln Memorial University - College of Dental Medicine Loma Linda University School of Dentistry Louisiana State University School of Dentistry Marquette University School of Dentistry McGill University Medical University of South Carolina James B. Edwards College of Dental Medicine Meharry Medical College School of Dentistry Midwestern University College of Dental Medicine – Arizona Midwestern University College of Dental Medicine – Illinois New York University College of Dentistry Nova Southeastern University College of Dental Medicine Ohio State University College of Dentistry Oregon Health and Science University School of Dentistry Roseman University of Health Sciences College of Dental Medicine Rutgers School of Dental Medicine Southern Illinois University School of Dental Medicine State University of New York at Buffalo School of Dental Medicine Stony Brook University School of Dental Medicine Texas A&M Health Science Center Baylor College of Dentistry The Herman Ostrow School of Dentistry of USC The Maurice H. Kornberg School of Dentistry at Temple University Touro College of Dental Medicine Tufts University School of Dental Medicine University of Alabama at Birmingham School of Dentistry University of Alberta Faculty of Dentistry University of British Columbia Faculty of Dentistry University of California at Los Angeles School of Dentistry University of California at San Francisco School of Dentistry University of Colorado Denver School of Dental Medicine University of Connecticut School of Dental Medicine University of Detroit Mercy School of Dentistry University of Florida College of Dentistry University of Illinois at Chicago College of Dentistry University of Iowa College of Dentistry University of Kentucky College of Dentistry University of Louisville School of Dentistry University of Manitoba College of Dentistry University of Maryland School of Dentistry University of Michigan School of Dentistry University of Minnesota School of Dentistry University of Mississippi School of Dentistry University of Missouri-Kansas City School of Dentistry University of Montreal University of Nebraska Medical Center College of Dentistry University of Nevada, Las Vegas School of Dental Medicine University of New England College of Dental Medicine University of North Carolina School of Dentistry University of Oklahoma College of Dentistry University of Pennsylvania School of Dental Medicine University of Pittsburgh School of Dental Medicine University of Puerto Rico School of Dental Medicine University of Saskatchewan College of Dentistry University of Tennessee Health Science Center College of Dentistry University of Texas Health Science Center at San Antonio Dental School University of Texas Health Science Center Dental Branch at Houston University of the Pacific Arthur A. Dugoni School of Dentistry University of Toronto Faculty of Dentistry University of Utah School of Dentistry University of Washington School of Dentistry University of Puerto Rico School of Dental Medicine Virginia Commonwealth University School of Dentistry West Virginia University School of Dentistry Western University of Health Sciences College of Dental Medicine Western University - Schulich School of Medicine & Dentistry Woody L. Hunt School of Dental Medicine Other OK Question Title * 7. What year did you graduate from dental school? 2019 2020 2021 2022 2023 2024 OK Question Title * 8. Are you able to attend the Fall Fellowship Review Course on Oct. 4-5 in Chicago, IL? Yes No OK Question Title * 9. In what ways have you been involved with AGD? (Please list any constituent or committee involvement, including any positions held.) OK Question Title * 10. What would receiving this scholarship mean to you? OK Question Title * 11. Please submit your CV: PDF, DOC, DOCX file types only. Choose File Choose File No file chosen Remove File Please submit your CV: OK Question Title * 12. Optional: Any publications you'd like to include with your application. (If multiple, please combine and upload as one file.) PDF, DOC, DOCX file types only. Choose File Choose File No file chosen Remove File Optional: Any publications you'd like to include with your application. (If multiple, please combine and upload as one file.) OK Question Title * 13. Optional: Any letters of recommendation you'd like to include with your application. (If multiple, please combine and upload as one file.) PDF, DOC, DOCX file types only. Choose File Choose File No file chosen Remove File Optional: Any letters of recommendation you'd like to include with your application. (If multiple, please combine and upload as one file.) OK Question Title * 14. Please confirm your understanding of the following statement. By checking the box, I hereby confirm my commitment to attending the review course and exam as required, in accordance with all specified details and regulations. OK Question Title * 15. Any other questions or comments? OK DONE