University of Pittsburgh - School of Dental Medicine

Center for Dental Informatics: Research Program

Please submit this form and wait with Step 2 of the application until you receive a message from one of the members of the admissions committee:

*Last name:**
*First name:**
MI:
*Address:**
*City:**
*State:**
*Zip:**
*Legal Residency (Country):**
*Citizenship (Country):**
*Daytime Phone:**
*E-Mail Address:**
*Educational institution (official name in English):**
*URL of own or institution's home page:**
*Program (name of the program you are enrolled in):**
*Desired internship period (From mm/dd/yyyy - To mm/dd/yyyy):**
*Your strongest computer skills, e.g. the programming language you are most familiar with or the software application you are an expert in:**
*Your weakest IT skills:**
*IT-related projects which you have completed:**
*Areas of interest which combine dentistry with informatics:**