Fellowships



 
Oral & Maxillofacial Residency Application
Please have PASS send a copy of your application materials to Chairman, Department of OMS & HD. Selected candidates will be contacted for an interview.

Please write, phone or e-mail for more information:

Edwin L. Granite, DMD
Chair, Department of Oral and Maxillofacial Surgery & Hospital Dentistry
Program Director, Oral and Maxillofacial Surgery Training
Chief, Oral and Maxillofacial Surgery
Wilmington Hospital
P.O. Box 1668
Wilmington, Delaware 19899
Phone: 302-428-6458
Fax: 302-428-6822
* required info
Date to Begin
Full Name *
Email Address *
Phone *
Current Address
City
State
Zip
Permanent Address
City
State
Zip
Do you have the legal right to work in the United States? Yes
No
Military Service
Social Security Number
Education outside USA? Yes
No
Type of Visa (if applicable)
Visa entry date
Licensed to practice Dentistry? * Yes
No
State Province or Country
Publications
Pre-dental (College)
Dates
Dental
Dates
Internship
Dates
Residency
Dates


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