American Dental Education Association



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American Dental Education Association

655 K Street NW, Suite 800


Washington, DC 20001

www.adea.org



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Dental Institute

Floor 18, Tower Wing

Guy’s Hospital

Great Maze Pond

London SE1 9RT



Association for Dental Education
in Europe  

Dublin Dental University Hospitalw:\dented\adee_general\adee_logos_stationery_procedures\logos_2010\adee_logo_jpg_2010.jpg

Trinity College

Dublin 2, D02 F859 Ireland

www.adee.org




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


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