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.

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* 1. Name:

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* 2. Email:

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* 3. AGD member ID:

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* 4. City of residence:

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* 5. Your constituent:

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* 6. What dental school did you graduate from?

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* 7. What year did you graduate from dental school?

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* 8. Are you able to attend the Fall Fellowship Review Course on Oct. 4-5 in Chicago, IL?

Yes

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* 9. In what ways have you been involved with AGD? (Please list any constituent or committee involvement, including any positions held.)

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* 10. What would receiving this scholarship mean to you?

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* 11. Please submit your CV:

PDF, DOC, DOCX file types only.

Choose File

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* 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

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* 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

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* 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.

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* 1. Name:

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* 2. Email:

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* 3. AGD member ID:

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* 4. City of residence:

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* 5. Your constituent:

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* 6. What dental school did you graduate from?

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* 7. What year did you graduate from dental school?

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* 8. Are you able to attend the Fall Fellowship Review Course on Oct. 4-5 in Chicago, IL?

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* 9. In what ways have you been involved with AGD? (Please list any constituent or committee involvement, including any positions held.)

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* 10. What would receiving this scholarship mean to you?

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* 11. Please submit your CV:

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* 12. Optional: Any publications you'd like to include with your application. (If multiple, please combine and upload as one file.)

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* 13. Optional: Any letters of recommendation you'd like to include with your application. (If multiple, please combine and upload as one file.)

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* 14. Please confirm your understanding of the following statement.

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* 15. Any other questions or comments?