Other Information

Select your native language (the language of your birth). If you speak additional languages, click Add Another Language. Then, select the language(s) and the level of your proficiency in each.

Indicate whether you've ever been convicted of a misdemeanor or felony. Note that most programs require satisfactory background check results as a condition of acceptance. Failure to disclose and provide accurate information about prior convictions may have serious consequences, such as annulment of acceptance offers, program dismissal, or other sanctions. 

Background checks reflect all prior convictions, guilty pleas, city ordinance citations (such as public intoxication), illegal possession(s) including possession of alcohol under the legal age, payments of fines (including traffic violations), and, in some cases, prior records thought to have been expunged. Note that in some states, common traffic violations may be considered misdemeanors. 

Candidates with criminal records due to felony offenses are encouraged to be aware of the potential impact for program acceptance and future licensure. Contact the programs you wish to apply to and state licensing agencies where you hope to practice for advice if you have a felony conviction or a criminal record. If you are uncertain of the status of a charge versus a conviction on your record, or if you are uncertain as to whether your offense was an infraction, misdemeanor, or a felony, contact the city, county, or state jurisdiction where the incident occurred.

If you are convicted of a misdemeanor or felony prior to admission and/or matriculation, it is your responsibility to immediately inform your program(s).

Indicate whether you have ever had any certification, registration, license, or clinical privileges revoked, suspended, or in any way restricted by an institution, state, or locality. If yes, enter an explanation in the spaces provided. 

Indicate whether you have ever been disciplined or placed on academic probation while attending an academic institution. If yes, enter an explanation in the spaces provided.

Enter your DENTPIN. This is a unique identification number that is assigned by the American Dental Association. Click here for more information or to obtain a DENTPIN.

Indicate if you have any relatives who are associated with the dental profession (this includes professional work, education, and related experiences).