Center for Dental Informatics: Research Program

Application Form

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*: