LETTERS of EVALUATION for a CREDENTIALS APPLICATION

LETTERS OF EVALUATION for a CREDENTIALS APPLICATION

INSTRUCTIONS

Letters of evaluation AND the completed Evaluation Form (page 12) are required from three (3) colleagues and shall be mailed directly by these individuals to:

Kathy Queck, DVM, FAVD Phone 704-588-9788

Secretary of the Academy of Veterinary Dentistry Fax 704-588-9781

The Carolinas Animal Hospital and Dental Clinic Email

13331 York Center Dr., Suite A, Charlotte, NC 28273

Evaluators shall use the evaluation form attached below. Evaluators are also REQUIRED to write a letter of evaluation. Evaluations should come from qualified professionals that are very familiar with veterinary dental techniques and procedures. Academy or College members who have personally observed your work are preferred and highly recommended. A dentist who has observed your work on several occasions could be acceptable. A general practitioner, who has referred multiple cases to you and has seen and followed the referred cases, could also be acceptable, but not as desirable. More weight is given to reference letters from veterinary dental experts than from other individuals.

Be sure to share the information above with the individuals who you ask to write your letters.

The form to be used by the Evaluator is on the next page……

Academy of Veterinary Dentistry

CREDENTIALS APPLICANT EVALUATION FORM

Applicant’s Name: ______

Evaluator’s Name: ______

FOR CONFIDENTIAL USE BY THE CREDENTIALS COMMITTEE

1. My field of expertise is in: Veterinary Dentistry ______; General Dentistry ______;

Dental Specialty ______; which Specialty? ______;

Referring DVM ______; Academic ______;

Other ______, (please explain)

2. During what period of time, [hours, days, months or year(s)] and in what capacity did you observe the veterinary dental activities of the applicant? Specifically mention the type of supervision you provided, e.g., mentoring, telephone consultations, performed procedures(s) with the applicant assisting, applicant performed procedures(s) with you assisting. If not applicable, please write N/A.

3. How closely did you supervise the applicant? (e.g., seldom, daily, weekly, monthly, or several times over a period of _____ months)

4. Which of the basic disciplines of veterinary dentistry (periodontics, endodontics, orthodontics, restorative and oral surgery) did you supervise or observe?

5. In terms of primary patient care responsibility, approximately how many cases were under the exclusive control of the applicant during your period of supervision or observation?

Not applicable ______Zero cases ______1-5 cases ______

6-10 cases ______11-25 cases ______Over 25 cases ______

• Attention to the patient as a whole ______

• Knowledge of dental radiographic technique and interpretation ______

• Proper management of veterinary dental cases ______

Continued

• Proper use of techniques and materials which are generally accepted ______

• Complete and adequate dental charting ______

• Awareness of current literature ______

• Ability to make independent decisions ______

7. Applicant’s characteristics. Please state: N/A, unknown, excellent, very good, satisfactory, needs improvement or unsatisfactory.

• Reliability ______

• Motivation ______

• Attention to detail (follows manufacturers instructions exactly) ______

• Client control and attitude ______

• Professional ethical standards ______

8. Do you believe that the applicant has any characteristics of professional performance that would detract from the applicant’s fitness for membership in the Academy of Veterinary Dentistry? If so, please describe.

Date: ______Signed ______

Print Name ______

Address: ______

City, State, Zip ______

Telephone: ______

FAX: ______

Please attach a letter of recommendation to support the applicant’s application for membership in the Academy.

The Academy greatly appreciates your time and effort in writing this evaluation.

This form must be sent directly to and received at the Secretary’s office no later than midnight, July 15. If the postmark is prior to July 8, the form will be accepted even if delayed in transit.

Mail to: Kathy Queck, DVM, FAVD, Secretary of the Academy of Veterinary Dentistry

Carolinas Animal Hospital and Dental Clinic, 13331 York Center Dr., Suite A,

Charlotte, NC 28273

Phone 704-588-9788 Fax 704-588-9781 Email