ADVANCED EDUCATION PROGRAMS

APPLICATION MATERIALS

Chairman, Advanced Education CommitteeUMKC School of Dentistry c/o Office of Student Programs

650 E. 25th StreetKansas City, MO 64108-2795

UPDATED JULY 2010

The following information is available at http://dentistry.umkc.edu/bec_student/AdvEdPrograms.htm .

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Thank you for your interest in the Advanced Education Programs of the University of Missouri-Kansas City School of Dentistry.

Advanced Education Programs

Chair, Advanced Education Committee: Jeffrey C. Nickel, DMD, MSC, PhD  

The School of Dentistry offers advanced education curricula leading to graduate certificates in four clinical dental specialty areas (endodontics, oral and maxillofacial surgery, orthodontics and dentofacial orthopedics, and periodontics), certificates in general dentistry, and master of science degrees in either oral biology or dental hygiene education. The School participates in the Interdisciplinary Ph.D. program through the Department of Oral Biology. Oral Biology's research focus areas are: Biomaterials/Bioengineering of Biological Tissues & Replacements, Mineralized Tissue Biology and Translational and Clinical Research.

Dental Graduate Certificate Programs

A graduate certificate program is offered in each of the following areas: Advanced Education in General Dentistry Endodontics Oral and Maxillofacial Surgery Orthodontics and Dentofacial Orthopedics Periodontics

Applicants applying to the graduate certificate program in graduate programs within Oral Biology or Dental Hygiene should not use this application and should contact those programs directly regarding their separate online application.

General Nature of Programs

Each certificate program curriculum is designed to prepare the student for specialty practice and to help the student meet the educational training requirements for examination by the appropriate American dental specialty board. All programs begin with the summer term (the first week of July) except for graduate Dental Hygiene education, which begins with the fall semester. Programs vary in length from 12 to 72 months.

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For specific program descriptions regarding the graduate dental certificate programs, please refer to http://dentistry.umkc.edu/bec_student/AdvEdPrograms.htm.

Application Deadlines

Application deadline dates for graduate dental certificate programs are as follows:

The deadline for receipt of applications at the school is one year before anticipated enrollment in the program.

(International applicants must have a U.S. or Canadian D.D.S. or D.M.D. from an accredited CDA or CDAC program to be considered for advanced education programs, except for the programs in Oral Biology. International applicants must use the UMKC International Application for Admission. These forms are available from the Office of Student Programs of the School of Dentistry or at www.umkc.edu/dentistry/assets/forms/advancededucation.htm.)

Application Information for Candidates Applying to Advanced Education in General Dentistry, Oral & Maxillofacial Surgery, and Orthodontics & Dentofacial Orthopedics

The graduate dental certificate programs in advanced education in general dentistry, oral and maxillofacial surgery, orthodontics and dentofacial orthopedics REQUIRE submission of application materials through the Postdoctoral Application Support Services (PASS). (Submission of application materials through the below UMKC School of Dentistry advanced education application may be supported in special circumstances only for the advanced education in general dentistry program.) All application materials should be sent to PASS and UMKC should be listed as a designation. An applicant copy of the PASS application should not be sent directly to UMKC. Be aware that approximately three weeks is required by the service to process PASS applications and deliver them to the designated programs. The length of this processing period should be considered by the candidate in order to meet relevant application deadlines.

The graduate certificate programs in oral and maxillofacial surgery AND orthodontics and dentofacial orthopedics participate in the National Matching Services (NMS / MATCH) process. For the 2011 admissions cycle PASS and NMS have partnered for the first time to provide a single access point for students applying to both services. Candidates apply through ADEA PASS and are placed by NMS. The NMS requires a completed Applicant Agreement and Rank Order List form to be submitted by the established deadline dates. There are two phases of the MATCH process, each with its deadline date for receipt of Rank Order List forms from applicants. The Phase I deadline (typically toward the middle of November) is for applicants to the orthodontics and dentofacial orthopedics program. The Phase II deadline (typically in the middle of January) is for those applying for admission to the oral and maxillofacial surgery.

More information may be learned about the PASS and NMS services at the links below:

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Advanced Education in General Dentistry

October 1

Endodontics August 15

Oral and Maxillofacial Surgery August 15

Orthodontics September 5

Periodontics August 15

ADEA PASS – www.adea.org NMS (MATCH) – www.natmatch.com

Orthodontic applicants must self-report GRE scores on the PASS application. Official GRE scores should be sent to UMKC School of Dentistry. The GRE code is 6872.

Once applications are received at the UMKC School of Dentistry candidates will be notified to submit an additional UMKC application fee. The UMKC application fee is $45 if you mail a check or $35 if you submit the UMKC application and payment online (http://www.umkc.edu/admissions/umkc-graduate-professional.asp ). Checks should be made payable to UMKC.

Undergraduate transcripts and official national board scores will be requested upon acceptance into the program.

General questions concerning advanced education programs should be directed to the chairman of the Advanced Education Committee at the mailing address above or at (816) 235-6322. However, specific questions regarding any advanced education program should be directed to the pertinent program director. Graduate program directors along with their telephone numbers are identified in a subsequent section.

Application Information for Candidates Applying to the Endodontics and Periodontics Programs

Applicants to the Endodontics and Periodontics programs of the School of Dentistry must submit all of the following information through the advanced education supplemental application below:

1. Application supplement.2. Curriculum vitae. 3. Original essay of one page describing their professional goals and desire to pursue the program you have selected. 4. References, preferably by a minimum of three faculties at your dental school who are capable of evaluating your

academic potential within the program. See applicant appraisal forms; each form should be submitted in a sealed envelope.

5. Academic Performance Evaluation Form or Dean’s Letter. 6. Official Transcripts (from undergraduate, dental, graduate and professional schools attended). 7. An official copy of Part I and II of your National Board Scores should be sent directly from the ADA Commission on

Dental Examinations. If Part II has not been completed, official scores will be required shortly following the exam. Passing scores on both sections are required.

8. Photograph, approximately two inches by two inches. 9. Class rank in dental school (if applicable). 10. Proof of a valid state dental license (if applicable).11. UMKC Application and UMKC Application fee. Domestic student fee of $35 when applying online

(http://www.umkc.edu/admissions/umkc-graduate-professional.asp ) ; $45 when submitting the below paper application – check payable to ‘UMKC.’ International student application fee of $50 (www.umkc.edu/isao.) (Applicants who have enrolled and completed coursework as a degree-seeking student at UMKC are exempt from paying the application fee a second time, but still must complete a new UMKC application.)

Additional information, as identified below, must be supplied by international student applicants: 1. TOEFL scores (minimum of 550 on the paper test or 213 on the computer based version) or a demonstrated

proficiency in the English language (if English is not the primary language of the applicant). 2. Financial statement (guarantee of full financial support or of sufficient financial resources for the entire cost of

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the program, including living expenses).

It is preferred that the application and required supporting documents be sent in one packet to the address below:

UMKC School of Dentistry - Advanced Education Committeec/o Office of Student Programs, Room 420650 East 25th StreetKansas City, MO 64108-2795

General questions concerning advanced education programs should be directed to the chairman of the Advanced Education Committee at the mailing address above or at (816) 235-6322. However, specific questions regarding any advanced education program should be directed to the pertinent program director. Graduate program directors along with their telephone numbers are identified in a subsequent section.

Requirements and Procedures for Admission

Admission to a graduate dental certificate program is competitive. Primary focus is on the applicant's academic record while in dental school, including national board scores. Emphasis is also placed on information gathered from letters of evaluation and curriculum vitae (such as quality of professional practice experience, continuing education experience, research activities, leadership and involvement and participation in professional societies and community service). Another fundamental source of information is supplied by a personal on-site interview that is required of most programs and is by invitation.

Applicants applying to a graduate dental certificate program must hold a D.D.S. degree or equivalent from a program accredited either by the Commission on Dental Accreditation (CDA) or the Canadian Dental Accrediting Commission (CDAC).

Admission

The Advanced Education Committee (AEC) serves as the admission review board for each of the graduate dental certificate programs. Each program has its own admission review board. At a minimum, the admission review board consists of the respective program director and at least two other full-time faculty members.

Each program's admission review board submits its recommendations for acceptance to the AEC for consideration. Recommendations for acceptance include those identified as prime candidates (equal in number to the number of available residencies in the program) and those who serve as "alternates." Acceptance or denial of each recommended candidate is made by the AEC.

Financial Assistance

Eligible advanced education students (i.e., those who have earned a D.D.S. or D.M.D. degree from a Commission on Dental Accreditation or Canadian Dental Accrediting Commission accredited program or who hold valid licenses to practice dentistry in one or more states of the United States) in the graduate certificate program of endodontics, general dentistry, oral and maxillofacial surgery, orthodontics and dentofacial orthopedics, and periodontics receive an annual financial assistance based on patient treatment fees.

Eligible graduate students in general dentistry, orthodontics and dentofacial orthopedics, periodontics and endodontics, participate in an incentive-based clinical income sharing program; 33 percent of the net fees collected for

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clinical treatment provided by a resident in one of these programs will be paid to the student. Net collected clinical fees are defined as gross clinical fees collected less scheduled laboratory fees incurred as a part of the treatment procedures and less any waivers granted (except those authorized for payment to the resident by the assistant dean for clinical programs).

Financial aid for advanced education students is also available in the form of a limited number of Chancellor's Non-Resident Awards or graduate research assistantships. The Chancellor's Non-Resident Award provides for the non-resident tuition only (i.e., the difference between Missouri resident and nonresident fees), while the graduate research assistantship includes a stipend plus an award equivalent to the basic education fees (at regular graduate student fee rate and not at the graduate dental student fee rate) for 6 hours of graduate credit for both fall and spring semesters. Both categories of awards are made on a competitive basis, with quality of academic record as a major criterion. History of research experience or potential for research in the graduate program also serves to identify candidates for the graduate research assistantship.

Other forms of financial aid may be available from federal loan programs (depending on whether or not lending limits have been reached) or from other funding agencies.

Statement of Human Rights: The Board of Curators and UMKC are committed to the policy of equal opportunity, regardless of race, color, creed, sex, age, national origin, disability, or Vietnam-era Veteran status. The Affirmative Action Office, 360 Administrative Center, 5115 Oak St., is responsible for all relevant programs. Call 816-235-1323 for information or go to ww.umkc.edu/adminfinance/eoaa. People with speech or hearing impairments may contact the University by using Relay Missouri, 1 800 735-2966 (TT) or 1 800 735-2466 (Voice).

Students’ Right to Know: In accordance with Public Law 101-542, UMKC reports 73.1 percent of its first-time freshmen return the second year. The UMKC Police Department publishes an annual campus report on personal safety and crime statistics. The report includes statistics for the previous three years concerning reported crimes that occurred on campus; in certain off-campus buildings owned or controlled by UMKC; and on public property within, or immediately adjacent to and accessible from the campus. The report also includes institutional policies concerning campus security, such as policies concerning alcohol and drug use, crime prevention, the reporting of crimes, sexual assault and other matters. The report is available at the UMKC Police Department, Room 213, 4825 Troost Building, or online at www.umkc.edu/safetyreport.

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UMKC APPLICATION FOR ADMISSION

(This paper application may be used for the following programs offered at the UMKC School of Dentistry: Advanced Education in General Dentistry, Endodontics, and Periodontics).

Note: The UMKC application may also be completed online at www.umkc.edu/admissions. If you are an international visa student (nonresident alien), do not use this form. Complete the application through ISAO at www.umkc.edu/isao

Applicant Information

Social Security Number:

Last Name, First Name, Middle:

Current Legal Address:

Current Legal City, State and Zip:

Current Mailing Address:

Current City, State and Zip:

Current County:

Home Phone: Cell Phone:

Work Phone:

Date of Birth:

E-mail Address:

Are you a Missouri resident? No Yes, how long have you been a Missouri resident:

Previous Legal Address, if less than 1 year in Missouri (city county state):

Are you a legal resident of Johnson, Leavenworth, Miami or Wyandotte County in Kansas? No Yes, how long:

Are you a U.S. citizen? Yes No, country of citizenship:

If resident alien, card number and date of issue (a copy of your card is required):

Enrollment Information

Have you ever applied to UMKC before? If yes, what semester and year? Have you previously enrolled at UMKC? If yes, last semester enrolled:

When will you enter UMKC? (semester and year):

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Do you plan to complete a degree at UMKC?The following information is optional. Gender and ethnic origin are requested for purposes of federal compliance reporting: Gender:

In effort to better serve our student population, design programming that is more inclusive and remain compliant with federal, state, local and several granting organizations, please indicate your ethnic or racial background:

I. Are you Hispanic/Latino? Yes No

II. Which of the following do you consider to be your racial background? Please place an “X” next to all races that apply and a “P” on the line next to your primary ethnicity type._____American Indian or Alaska Native _____White _____Black/African American_____Asian(underrepresented) _____Native Hawaiian or other Pacific Islander_____Asian (includes Chinese, Filipino, Japanese, Korean, Asian Indian or Thai)

Did one or both of your parents graduate from college?

Did one or both of your parents graduate from UMKC?

Educational Information

High School Attended (name, city and state):

Date of Graduation or GED Diploma:

Name and location of all colleges and universities attended prior to enrollment at UMKC, including dates of attendance and degrees earned or expected. Include all colleges or universities from which you have earned dual credit. Please request all colleges and universities send official transcripts of course work.

Name of School Location (city, state) Dates of Attendance Degree Earned/Anticipated

Select a ProgramIn the space below, please indicate the programs you are applying to and be sure to include the program number: Advanced Education in General Dentistry 033000; Endodontics 204000; Periodontics 483000.___________________________________________________________________________________________

Please read carefully: I certify the information on this application is accurate and complete and I understand that all required credentials must be submitted before an admission decision may be made. I authorize the University of Missouri-Kansas City to maintain all my records under my signed name and I understand these records and credentials in support of my application are the property of UMKC and may not be returned or reproduced.

Date: __________________________Signature: ___________________________________________________

Please return this completed form and your check for the $45.00 non-refundable application fee as a part of the application packet. (Applicants who have enrolled and completed coursework as a degree-seeking

student at UMKC are exempt from paying the application fee a second time.)

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UNIVERSITY OF MISSOURI-KANSAS CITY

SCHOOL OF DENTISTRY - ADVANCED EDUCATION PROGRAMS

APPLICATION SUPPLEMENT(Please TYPE or PRINT your responses for the following items)

Name:

Street address:

City, State, Zip:

Application for advanced education study in:

Have you previously applied to an advanced education program at UMKC School of Dentistry? If yes, please list programs and application date:

National Board certificate (enclose copy): Part I (Date) Part II (Date)

State/Regional Licensing Board Examination(s) passed:

List positions held, professional or other:

Position or Practice Location Dates

Memberships held in professional or honorary societies:

Indicate other honors or awards:

List papers published or in press:

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Please supply names and academic positions of three members of your School of Dentistry faculty who have knowledge of your character and training and have indicated a willingness to write in support of this application. Letters from other dentists not related to you by birth or marriage may also be offered in support of your application.

Name:

Position:

Name:

Position:

Name:

Position:

Applicant Signature: Date:

Please return this completed form as a part of the application packet.

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UNIVERSITY OF MISSOURI-KANSAS CITY

SCHOOL OF DENTISTRY

ADVANCED EDUCATION PROGRAMS

ACADEMIC PERFORMANCE EVALUATION FORM

TO BE COMPLETED BY THE DEAN OF THE SCHOOL OF DENTISTRY

(Please TYPE or PRINT your responses for the following items)

A strictly confidential evaluation of this applicant for use by the University of Missouri-Kansas City School of Dentistry will be appreciated.

Applicant's name: Social Security Number:

Application for advanced education study in:

Name of dental school attended:

Date of Graduation / Anticipated Date of Graduation:

Name of Dean (please type or print):

Student has waived the right to access to this evaluation.

Student has not waived the right of access to this evaluation.

NATIONAL BOARD SCORES Part 1 Part 2

Exam Date

AnatSci

BiochemPhys

MicroPath

DentAnat

Average ReferenceNumber

ExamDate

Average

DENTAL CLASS RANKING

Class Size

Yearly GPA

YearlyStanding

1st

2nd

3rd

4th

OVERALL GPA/CLASS RANKING

Cum GPA:

Cum Ranking:

Class GPA Range:

School does not rank its students

AttributeExceeds

ExpectationsMeets

ExpectationsDoes not Meet Expectations

Not Observed

Professional Appearance/ Demeanor

Assumes Responsibility

Initiative

Reliability

Maturity

Ethical Behavior

Please check one: Do Not Recommend Recommend Highly Recommend Highest Recommendation

Comments may be included in the space below or by attaching a separate letter:

Signature: Date:

Please attach your business card and return this completed form, in a SEALED envelope to the applicant to return as a part of the application packet (please sign the flap of the envelope).

UNIVERSITY OF MISSOURI-KANSAS CITY SCHOOL OF DENTISTRY

ADVANCED EDUCATION PROGRAMS - APPLICANT APPRAISAL FORM

TO BE COMPLETED BY A MEMBER OF THE SCHOOL OF DENTISTRY FACULTY(Please TYPE or PRINT your responses for the following items)

A strictly confidential evaluation of this applicant for use by the University of Missouri-Kansas City School of Dentistry will be appreciated.

Applicant's name: Social Security Number:

Application for advanced education study in:

Name of dental school attended:

Name of Referee: Title:

Student has waived the right to access to this evaluation.

Student has not waived the right of access to this evaluation.

How long have you known this applicant?

In what capacity have you known this applicant? Lecture/Seminar Clinic Research Environment Advisor Please complete the evaluation below regarding the student=s performance compared to others who have attended your institution.

AttributeExceeds

ExpectationsMeets

ExpectationsDoes not Meet Expectations

Not Observed

Professional Appearance/ Demeanor

Assumes Responsibility

Initiative

Reliability

Maturity

Ethical Behavior

Please check one: Do Not Recommend Recommend Highly Recommend Highest Recommendation

Comments may be included in the space below or by attaching a separate letter:

Signature: Date:

Please attach your business card and return this completed form, in a SEALED envelope to the applicant to return as a part of the application packet (please sign the flap of the envelope).

UNIVERSITY OF MISSOURI-KANSAS CITY SCHOOL OF DENTISTRY

ADVANCED EDUCATION PROGRAMS - APPLICANT APPRAISAL FORM

TO BE COMPLETED BY A MEMBER OF THE SCHOOL OF DENTISTRY FACULTY(Please TYPE or PRINT your responses for the following items)

A strictly confidential evaluation of this applicant for use by the University of Missouri-Kansas City School of Dentistry will be appreciated.

Applicant's name: Social Security Number:

Application for advanced education study in:

Name of dental school attended:

Name of Referee: Title:

Student has waived the right to access to this evaluation.

Student has not waived the right of access to this evaluation.

How long have you known this applicant?

In what capacity have you known this applicant? Lecture/Seminar Clinic Research Environment Advisor Please complete the evaluation below regarding the student=s performance compared to others who have attended your institution.

AttributeExceeds

ExpectationsMeets

ExpectationsDoes not Meet Expectations

Not Observed

Professional Appearance/ Demeanor

Assumes Responsibility

Initiative

Reliability

Maturity

Ethical Behavior

Please check one: Do Not Recommend Recommend Highly Recommend Highest Recommendation

Comments may be included in the space below or by attaching a separate letter:

Signature: Date:

Please attach your business card and return this completed form, in a SEALED envelope to the applicant to return as a part of the application packet (please sign the flap of the envelope).

UNIVERSITY OF MISSOURI-KANSAS CITY SCHOOL OF DENTISTRY

ADVANCED EDUCATION PROGRAMS - APPLICANT APPRAISAL FORM

TO BE COMPLETED BY A MEMBER OF THE SCHOOL OF DENTISTRY FACULTY(Please TYPE or PRINT your responses for the following items)

A strictly confidential evaluation of this applicant for use by the University of Missouri-Kansas City School of Dentistry will be appreciated.

Applicant's name: Social Security Number:

Application for advanced education study in:

Name of dental school attended:

Name of Referee: Title:

Student has waived the right to access to this evaluation.

Student has not waived the right of access to this evaluation.

How long have you known this applicant?

In what capacity have you known this applicant? Lecture/Seminar Clinic Research Environment Advisor Please complete the evaluation below regarding the student=s performance compared to others who have attended your institution.

AttributeExceeds

ExpectationsMeets

ExpectationsDoes not Meet Expectations

Not Observed

Professional Appearance/ Demeanor

Assumes Responsibility

Initiative

Reliability

Maturity

Ethical Behavior

Please check one: Do Not Recommend Recommend Highly Recommend Highest Recommendation

Comments may be included in the space below or by attaching a separate letter:

Signature: Date:

Please attach your business card and return this completed form, in a SEALED envelope to the applicant to return as a part of the application packet (please sign the flap of the envelope).