This course will take place November 5-9, 2012 at the Forsyth Institute in Cambridge, MA.

All interested candidates must fill out and submit this application, then separately submit a current CV by e-mail to

Please complete all questions by either clicking the button next to your answer or typing your answer in the appropriate field.

If you encounter any difficulties, please contact Erica Vassilos, Manager of the ADA Center for Evidence-Based Dentistry at 312.440.2523 or

* 1. What is your name, address, telephone number, and e-mail address?

* 2. Are you a current member of the American Dental Association?

* 3. Please list your degrees and the year you graduated from dental school (or your final degree).

* 4. Please list your employer and describe your current position.

* 5.

* 6. What is your current occupation?

* 7. What would you consider to be your level of training in evidence-based dentistry?

* 8. Please let us know why you are interested in attending this course. (Response should be 150 words or less).

* 9. Please provide a work-based clinical question that you would like to answer during the course and indicate why this question is important to you.

* 10. Please indicate how often you use the following:

  Never Used Occasional Use Frequent Use
The internet
Cochrane Library
ADA's EBD website
Other health-related databases