Note: Ensure You Include a 1000 Word Sample of You Academic Writing Style

American Dental Education Association
655 K Street NW, Suite 800
Washington, DC 20001
/ King’s College London
Dental Institute
Floor 18, Tower Wing
Guy’s Hospital
Great Maze Pond
London SE1 9RT / Association for Dental Education
in Europe
Dublin Dental University Hospital
Trinity College
Dublin 2, D02 F859 Ireland

Shaping the Future of Dental Education Rapporteur/Recorder Application form
Title (Dr/Mr/Mrs/Ms etc)
Name
Date of Birth
Address where currently faculty
e-mail address
Contact telephone number
Present post title
Years in post
Select preferred workshop / Global Networking: the how and why for dental educators / Inter professional Education: an imperative for dental education / The impact of new technological and scientific discoveries on traditional dental education / Assessment in a global context
Please detail your training and experience post dental degree with special emphasis on Dental Education. Please include any particular topics of interest/research activities within dental education and how they align with the your preferred workshop theme (max 500 words)
Discuss what you view as the key regional and international priorities for dental education in your preferred workshop theme (max 500 words)
Please discuss the roles of ADEA/ADEE as you see it with regards to the future of dental education internationally (max 500 words)
Signature of applicant
Date submitted

Note: Ensure you include a 1000 word sample of you academic writing style

Include two referees from local senior academic colleagues using the following form

Shaping the Future of Dental Education London 2017
Rapporteur Referees Report
Name of applicant
Title of referee
Name of referee
Present position of referee
Email address of referee
Please state the candidates age range / 20-25 25-30 30-35 35-40 40-45 45-50 50-55 55-60
What is the candidate’s faculty status
What is the candidate’s local contribution to dental education (Max 300 words)
What is the candidate’s contribution to International Dental Education (Max 300 words)
Please detail the candidate’s long term career progression and potential contribution to dental education (Max 300 words)
Can the candidate dedicate sufficient time to deliver the work load as outlined in the application
Please give a brief character reference for this candidate (Max 300 words)
Referees signature
Date signed

Shaping the Future of Dental Education: A Joint ADEA/ADEE initiative

Hosted by King’s College London 8th and 9th May 2017