The 2013 adea aadsas application Biographic Information

You may make revisions to this section any time during the application process. After February 1, submit all changes directly to your designated dental schools.

ADEA AADSAS and the dental schools will use this address to send you any correspondence. If your address changes at any time during the application process, login to your application and update your address. Keeping your Preferred Address updated helps assure that you do not miss important information.

 If needed, enter an apartment number or additional address information in this field. If not, leave this field blank 

 Type the name of your city  

   Select your country from the pull down menu


State/Province

   Select your state or province from the pull down menu



Zip Code

   Enter your zip or postal code



County

   Enter the name of your county



Telephone

   Provide the phone number where admissions officers can contact you   

If your phone number changes, login to your ADEA AADSAS application account and update. If you do not live in the United States, enter your local telephone number in this field. You can enter your Telephone Country Code and Telephone City Code in the fields below.

Cell Number

   Provide the cell phone number where admissions officers can contact you   

If your phone number changes, login to your ADEA AADSAS application account and update.

Fax Number

    Enter a fax telephone number, if one is available



Telephone Country Code (non-U.S.)

    If you do not live in the United States, enter your Telephone Country Code



Telephone City Code (non-U.S.)

   If you do not live in the United States, enter your Telephone City Code



Email Address

  Preferred Email Address  

Email is the primary mode of communication between ADEA AADSAS and applicants. Urgent ADEA AADSAS correspondence will only be sent to you via email. Be sure to keep your email address updated at all times. It is the applicant’s responsibility to regularly check both their email and ADEA AADSAS application for important messages from ADEA AADSAS. Providing an incorrect email address will result in you not receiving important messages from ADEA AADSAS and/or the dental schools.

Some email messages from ADEA AADSAS are sent to multiple applicants, which makes some email systems identify ADEA AADSAS messages as spam or junk email. Some email providers use filters to prevent users from receiving spam. Email filters may interpret an email from ADEA AADSAS or a dental school as spam and automatically delete a message to you about the status of your application. To avoid missing important ADEA AADSAS emails, turn the “spam” or “junk” email filters off during the application cycle. If your email provider does not allow you to turn the filter off, you may have to access a “junk mail file” that archives all messages identified as sent to multiple addresses. Periodically check your spam/junk email file for ADEA AADSAS or dental school related messages. If you do not currently have an email address or are unable to turn off the spam/junk filters described, please establish a new email account.

These are a few free email services for you to consider. (This is not a comprehensive list and does not reflect an endorsement or guarantee of reliable service.)

• 
  Yahoo.com
  
• 
  Email.com
  
• 
  Hotmail.com
  
• 
  Gmail.com
  

   Enter your permanent and/or legal address information if different from your Preferred Address   

Select “Click here if this information is the same as the Preferred Address.” If your permanent address changes, login to your ADEA AADSAS application account and update your permanent address online.

Street, Line 1

   Enter your Permanent Address   

ADEA AADSAS and the dental schools will use this address to send you any correspondence. If your address changes at any time during the application process, login to your application and update your address. Keeping your Permanent Address updated helps assure that you do not miss important information.

Street, Line 2

   If needed, enter an apartment number or additional address information in this field. If not, leave this field blank



City

   Type the name of your city



Country

   Select your country from the pull down menu



State/Province

   Select your state or province from the pull down menu



Zip Code

   Enter your zip or postal code



County

    Enter the name of your county



Telephone

   Provide the phone number where admissions officers can contact you   

If your phone number changes, login to your ADEA AADSAS application account and update. If you do not live in the United States, enter your local telephone number in this field. You can enter your Telephone Country Code and Telephone City Code in the fields below.

Telephone Country Code (non-U.S.)

   If you do not live in the United States, enter your Telephone Country Code



Telephone City Code (non-U.S.)

   If you do not live in the United States, enter your Telephone City Code



Fax Number

   Enter a fax telephone number, if one is available



Gender

☐ Male

☐ Do not wish to report

Many schools want to know more about your background. Providing information about your ethnicity and race requires answering a two-part question: First, you must indicate if you consider yourself to be of Hispanic origin. Second, you may select the racial classification(s) that you use to describe yourself. You can select one or more racial classifications. Within some categories of race, you are also asked to specify your ethnicity (e.g., Asian Indian, Cambodian, Chinese, etc.). Select any classifications that you use to identify yourself.

Consider these definitions when selecting your ethnicity and race.

• 
  Hispanic or Latino
  
  1. 
     person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
     
• 
  American Indian or Alaska Native
  
  1. 
     person having origins in any of the original peoples of North and South America (including Central America) who maintains cultural identification through tribal affiliation or community attachment.
     
• 
  Asian
  
  1. 
     person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.  Black or African American
     

• 
  Native Hawaiian or Other Pacific Islander
  
  1. 
     person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
     
• 
  White
  
  1. 
     Person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
     

☐ Yes

If yes, select the Hispanic/Latino/Latina box, and check all that apply below:

☐ Cuban

☐ Mexican, Mexican American, Chicano/Chicana

☐ Puerto Rican

☐ South or Central American

☐ Other Spanish culture or origin

☐ If other, please specify in the box provided.

If No, select the No, not Hispanic/Latino/Latina box.

Race

Which of the following best describe your race? Please mark one or more races.

☐ American Indian or Alaska Native

Please specify the name of your enrolled or principal tribe.

☐ Asian

Please check all of the below that apply:

☐ Asian Indian

☐ Cambodian

☐ Chinese

☐ Filipino

☐ Japanese

☐ Korean

☐ Malaysian

☐ Pakistani

☐ Vietnamese

☐ Other Asian

If other, please specify in the box provided.

  Other   

☐ Black or African-American

☐ Native Hawaiian or Other Pacific Islander

Please check all of the below that apply:

☐ Guamanian or Chamorro

☐ Native Hawaiian

☐ Samoan

☐ Other Pacific Islander

If other, please specify in box provided.

  Other   

☐ White

Place of Birth/Citizenship Information

    Enter the full name of the city where you were born. Do not use abbreviations   

   Enter the month-day-year of your birth in the following format: MM/DD/YYYY



City of Birth

   Enter the month-day-year of your birth in the following format: MM/DD/YYYY



State/Province of Birth

   Select the state/province in which you were born from the drop-down menu box

If you were born outside the U.S./Canada, select “No State.”

Country of Birth

   Select the country in which you were born from the drop-down menu box



Country of Citizenship

   Select your country of citizenship from the drop-down menu box

State/Province of Legal Residence

   Select the state/province of which you are currently a legal resident



Number of years living in U.S.

   Enter the number of years you have been living in the United States



Do you have U.S Military Experience?

☐ Yes

☐ N/A

• 
  If you have any type of Visa, you are not a U.S. Citizen. Refer to the non-U.S. Country codes.
  
• 
  If you are currently applying for U.S. citizenship, but it has not been granted, you are not a U.S. citizen.
  
• 
  If you are not a U.S. citizen, please report your Visa Information.
  

If you are a holder of a U.S. Visa, select the current status of your visa.

☐ Permanent Resident (Green Card)

☐ B-1 (Visitor for Business) ☐ B-2 (Visitor for Pleasure) ☐ F1 (Student) ☐ F2 (Spouse or Child of Student) ☐ H1-B (Specialty Occupation) ☐ J-1 (Exchange Visitors)

☐ S2 (permanent resident but not a citizen) ☐ G (Employees of international organizations that are located in the United States) ☐   Other    ☐ Currently do not have a U.S. visa status

*If you are a Permanent Resident you do not have to complete the remaining fields of this section.

   Enter the full name of the city that issued your Visa. Do not use abbreviations



Country of Visa Issue:

   Select the country where your Visa was issued from the pull down menu



General

Do you have any ADEA AADSAS documents under another name?

☐ Yes

ADEA AADSAS allows you to list alias names you may use. If you have required documents for your ADEA AADSAS application that we may receive under an alias name (Example: Personal Statements), you must record that information in this section. You have the option to list up to two first names, middle names, and last names. You should also list your preferred name or nickname to be sure that ADEA AADSAS can identify documents that we may receive for you under those names.

  Alias (First/Middle/Last) Names   

Parent and Family Information

You will UnotU be able to revise this section after e-submitting your ADEA AADSAS application. Review your entries carefully before submitting.

Complete related questions as thoroughly as possible. If a parent is deceased or unknown, select that option and you do not need to complete questions related to that parent (address, phone number, occupation, legal state of residency, and highest level of education).

Parent 1

Relationship to Applicant

    Select the relationship of parent to the applicant from the drop-down menu box



Indicate If Parent Is

Select the status of parent from the drop-down menu box:

☐ Living

☐ Deceased

☐ Unknown

Please skip all questions below if Unknown.

   Select the prefix from the drop-down menu box



First Name

   Enter the first name of the specified parent



Last Name

   Enter the last name of the specified parent



Middle Initial

   Enter the middle initial of the specified parent



Street, Line 1

   Enter the house number and street name of the permanent address of the specified parent



Street, Line 2

   If needed, enter an apartment number or additional address information in this field. If not, leave this field blank



City

   Type the name of the parent’s city of residence



State/Province

   Select the state or province from the pull down menu   

   Select the country from the pull down menu



Zip Code

   Enter the zip or postal code



Telephone

    Provide the phone number of the specified parent   

If parent does not live in the U.S. enter the local telephone number of the country where the parent resides. You can enter the Telephone Country Code and Telephone City Code in the below fields below.

Telephone Country Code (non-U.S.)

    If this parent does not live in the United States, enter the Telephone Country Code



Telephone City Code (non-U.S.)

   If this parent does not live in the United States, enter the Telephone City Code



Occupation

   Enter the occupation of the specified parent



Education

   Select the level of education completed by the specified parent from the drop-down menu box



Parent 2

Relationship to Applicant

   Select the relationship of parent to the applicant from the drop-down menu box



Indicate If Parent Is

Select the status of parent from the drop-down menu box:

☐ Living

☐ Deceased

☐ Unknown

Title

   Select the prefix from the drop-down menu box



First Name

   Enter the first name of the specified parent



Last Name

   Enter the last name of the specified parent  

   Enter the middle initial of the specified parent



Street, Line 1

   Enter the house number and street name of the permanent address of the specified parent



Street, Line 2

 If needed, enter an apartment number or additional address information in this field. If not, leave this field blank



City

   Type the name of the parent’s city of residence



State/Province

   Select the state or province from the pull down menu



Country

   Select the country from the pull down menu



Zip Code

   Enter the zip or postal code



Telephone

    Provide the phone number of the specified parent   

If parent does not live in the U.S., enter the local telephone number of the country where the parent resides. You can enter the Telephone Country Code and Telephone City Code in the below fields below.

Telephone Country Code (non-U.S.)

   If the parent does not live in the United States, enter the Telephone Country Code



Telephone City Code (non-U.S.)

   If the parent does not live in the United States, enter the Telephone City Code



Occupation

   Enter the occupation of the specified parent



Education

   Select the level of education completed by the specified parent from the drop-down menu box



Siblings

   Indicate the number of brothers and sisters you have. Enter 9 if you have 9 or more

________________________________________________________________________________________

Background Information

You will UnotU be able to revise this section after e-submitting your ADEA AADSAS application. Review your entries carefully before submitting.

 The text box allows you to provide a brief description of any activities you wish to list. You are limited to 600 characters, including spaces. 

 If "yes", indicate name, relationship, and name of school, dental degree or certificate, year of graduation or expected graduation. You are limited to 600 characters, including spaces. 

 If you answered “yes” enter an explanation here regarding each disqualification, suspension, dismissal, or disciplinary action. 

Include (1) a brief description of situation, (2) the specific charge(s) made, (3) the disciplinary action taken, and (4) a reflection on the experience and how the experience has affected your life. You are limited to 600 characters, including spaces.

Note: Answering “yes” will not automatically disqualify you for admission to a dental program. Many individuals learn from the past and emerge stronger as a result. Full disclosure enables programs to evaluate more effectively within the context of your credentials. Dental Schools may request verification from institutions previously attended that you were not involved in disciplinary actions. Failure to provide accurate information in response to this question may jeopardize your application to dental school. You are limited to 600 Characters, Including spaces.

Applicants often ask if they answer “yes” to this item, will their chances of admission be diminished? As the information above indicates, it may or it may not. However, failing to answer truthfully could certainly jeopardize your application.

Applicants often ask if they answer “yes” to this item, will their chances of admission be diminished? As the information above indicates, it may or it may not. However, failing to answer truthfully could certainly jeopardize your application.

 If "yes", include the name of schools to which you applied and year(s) of application. If accepted/enrolled, indicate dates of enrollment. 

 If "yes", indicate school(s), type of program, year applied, and also indicate if you were accepted and/or enrolled. 

Indicating “yes” to this item does not necessarily jeopardize your candidacy to dental school, but you should be prepared to tell admissions committees why you are applying to two (or more) types of programs simultaneously.

 If "yes", indicate school(s), type of program, year applied, and also indicate if you were accepted and/or enrolled. 

Admissions committees are interested in knowing of any special challenges you may have faced, as well as how you dealt with those challenges as you moved toward to educational goals. You are limited to 600 characters, including spaces.

Q8. Dental students interact with patients from many backgrounds. Other than English, indicate any language in which you feel comfortable conversing with native speakers.

   You have the ability to choose up to two additional languages.

_________________________________________________________________________________________

Disadvantaged Status

You will UnotU be able to revise this section after e-submitting your ADEA AADSAS application. Review your entries carefully before submitting.

Many dental schools seek to identify applicants who come from disadvantaged backgrounds. If you identify yourself as disadvantage, answer the questions in this section.

Do you wish to be considered a disadvantaged applicant by any of your designated dental schools that may consider such factors (social, economic, or educational)?

☐ Yes

If Yes, Please answer the following questions:

 Enter an explanation in this field. Please limit your answer to 4500 characters. 

   Select from the pull down menu.    

   Select state or province from pull down menu.



County

   Enter County in this field.