HSORESIDENT.COM ONLINE PROFILE FORM Question Title * 1. Resident/Doctor Name First Name Last Name Question Title * 2. Best Email Address Question Title * 3. Best Cell Phone/Text Question Title * 4. Gender (optional) Male Female Question Title * 5. Ortho Program Attended Alabama - Birmingham Arizona - AT Still California - UOP - Pacific California - USC - SoCal California - UCLA California - UCSF - San Francisco California - Loma Linda Colorado - CU Connecticut - UCONN DC - Washington Hospital DC - Howard University Florida - NOVA Florida - Jacksonville Florida - UFL - Gainesville Georgia - GA School of Ortho Georgia - Augusta Univeristy Illinois - UIC - Chicago Indiana - IU - Indianapolis Iowa - UIOWA Kentucky - UKY - Lexington Kentucky - Louisville Louisiana - LSU Maryland - Baltimore Massachusetts - Boston University Massachusetts - Tufts University Massachusetts - Harvard University Michigan - Detroit Mercy Michigan - UMICH - Ann Arbor Minnesota - UMN - Minneapolis Minnesota - Mayo - Rochester Missouri - SLU - Saint Louis Missouri - UMKC - Kansas City Nebraska - Lincoln Nevada - UNLV - Las Vegas Nevada - Roseman University New Jersey - Rutgers University New York - Maimonides Med Ctr New York - Bronx-Lebanon Hospital New York - NYU Lutheran Med Ctr New York - Stony Brook New York - Saint Barnabas Hospital New York - URMC - Rochester New York - NYU New York - UB - Buffalo New York - Columbia University New York - Montefiore Med Ctr North Carolina - UNC Ohio - OSU - Columbus Ohio - Case Western - Cleveland Oklahoma - OUHSC Oregon - Portland Pennsylvania - UPENN Pennsylvania - Temple Pennsylvania - Seton Hill Pennsylvania - PITT Pennsylvania - Einstein Med Ctr Puerto Rico - UPR South Carolina - MUSC Tennessee - UTHSC - Memphis Tennessee - Vanderbilt Texas - UT San Antonio Texas - Baylor College of Dentistry Texas - TORP - Lackland AFB Texas - UT Houston Virginia - VCU Washington - UW - Seattle West Virginia - WVU Wisconsin - Marquette Other (please specify) Question Title * 6. Graduation Month 01 02 03 04 05 06 07 08 09 10 11 12 Question Title * 7. Graduation Year 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Top 2 Rank of Locations Desired to Practice Question Title * 8. First Choice - State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Question Title * 9. First Choice - City (optional) Question Title * 10. Second Choice - State (optional) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Question Title * 11. Second Choice - City (optional) Question Title * 12. Interested in our exclusive Job Match program to search for orthodontic opportunities with top DSO's across the country? Yes No Question Title * 13. Interested in receiving information on our new HSO Grad Package deals for startup orders and financial assistance after graduation? Yes No Question Title * 14. Preference on Bracket Slot .018 .022 Question Title * 15. Preference on Bracket RX Roth MBT Question Title * 16. Preference on treatment type I prefer Conventional Brackets I prefer Self-Ligating Brackets I prefer Clear Aligners No preference Question Title * 17. Preference on Class II Correction Carriere Motion 3M Forsus Herbst No preference Done