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APPLICATION FORM

APPLICANTS PERSONAL INFORMATION
(AS PER THE PASSPORT)
FIRST NAME

GENDER
MIDDLE NAME

CITIZENSHIP
LAST NAME

PASSPORT NUMBER
MAIDEN OR PRIOR NAME

EIDA IDENTIFICATON NUMBER
DATE OF BIRTH

EMAIL ADDRESS
MARITAL STATUS

MOBILE TELEPHONE
HOME TELEPHONE



MAILING ADDRESS IN UAE HOMECOUNTRY ADDRESS
(FOR INTERNATIONAL STUDENTS)
STREET

STREET
CITY

CITY
COUNTRY

COUNTRY
POSTAL CODE

POSTAL CODE

INDICATE THE SOURCE OF FUNDING:

SELF PAYEE SCHOLARSHIP
PLEASE SPECIFY THE SPONSOR ____________________


INDICATE THE SPECIALTY IN WHICH YOU ARE INTERESTED:

ENDODONTICS
ORAL SURGERY
ORTHODONTICS
PAEDIATRIC DENTISTRY
PERIODONTOLOGY
PROSTHODONTICS



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EDUCATIONAL INFORMATION
List in chronological order all colleges and graduate or professional schools attended.


INSTITUTION


LOCATION

DATES ATTENDED

DEGREE GRANTED




SELF-REPORTED SCORES

DENTAL SCHOOL CLASS RANK


NUMBER OF DENTAL GRADUATES IN YOUR
CLASS


TOEFL SCORE


IELTS SCORE


(For students outside UAE)
EDUCATIONAL CREDENTIAL
EVALUATORS(ECE) TRANSCRIPT EVALUATION
USA GRADE POINT AVERAGE (GPA)



PROFESSIONAL EMPLOYMENT

ORGANISATION

LOCATION

JOB TITLE

EMPLOYMENT DATES










INTERNSHIP EXPERIENCE

ORGANISATION/LOCATION

DATES ATTENDED




RESEARCH EXPERIENCE

ORGANISATION AND TOPIC

RESPONSIBILITIES

DATE











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PROFESSIONAL PUBLICATIONS OR PRESENTATIONS

PROFESSIONAL
PUBLICATIONS OR
PRESENTATIONS

ORGANISATION OR JOURNAL

DATE







PROFESSIONAL MEMBERSHIP

ASSOCIATION

RESPONSIBILITIES/ACTIVITIES

DATE







VOLUNTEER EXPERIENCE

ASSOCIATION

RESPONSIBILITIES/ACTIVITIES

DATE







PERSONAL STATEMENT OF QUALIFICATIONS AND OBJECTIVES
Please attach a one or two page personal statement describing your motivation for specialized training.
Relate your interest to your formal education, current employment, and career aspirations. Please include
your full name and programme of interest on each page.


APPLICATION CHECKLIST
Submit the following materials and ensure that each supporting materials is clearly marked with your
name to aid in identification and completion of your application file. All materials submitted will become
part of your application file and will not be returned to you.

Completed and signed application form
Application fee payment (AED 350)
Personal Statement describing your qualifications and objectives
Curriculum Vitae
Original Academic Transcripts
(Attested by the Ministry of Higher Education for international students)
https://www.mohesr.ae/attestation/aboutgraduate.aspx
TOEFL score (iBT) minimum 85; computer minimum 213; or IETLS score 6.0 or

Cambridge English: Advanced Test Score of 52.
(Toefl and IELTS score delivered by hand is not acceptable. The institute required to only accept
TOEFL/IELTS scores forwarded by ETS.)


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Educational Credential Evaluators (ECE) course-by-course evaluation to evaluate the transcripts and have
a standard GPA (http://www.ece.org)
Original Diplomas
Original Evaluation from Dental School Dean (advantage to the applicant if present)
Original Evaluation from Dental School Faculty 1
Original Evaluation from Dental School Faculty 2
Original Evaluation from Professional Colleague (optional)
(The above Evaluation letters should be dated not more than one year)
6 Photographs
Passport Copy
EIDA ID card copy

REFERENCES AND PROFESSIONAL EVALUATIONS
List names and addresses of those individuals providing evaluation letters.

(1) DENTAL SCHOOL DEAN (2) DENTAL SCHOOL FACULTY
NAME

NAME

TITLE

TITLE

INSTITUTION

INSTITUTION

EMAIL ADDRESS

EMAIL ADDRESS

TELEPHONE NUMBER

TELEPHONE NUMBER


(2) DENTAL SCHOOL FACULTY 2 (4) PROFESSIONAL COLLEAGUE (OPTIONAL)
NAME

NAME

TITLE

TITLE

INSTITUTION

INSTITUTION

EMAIL ADDRESS

EMAIL ADDRESS

TELEPHONE NUMBER

TELEPHONE NUMBER


I HEREBY CERTIFY THAT THE INFORMATION SUBMITTED IN THIS APPLICATION IS TRUE AND
CORRECT.

SIGNATURE



DATE