Residency ProgramsGeneral Practice Dentistry

General Practice Dentistry Application

Please have PASS send a copy of your application materials to Vice Chairman Department of OMS&HD. Selected candidates will be contacted for an interview. Please write, phone or e-mail for more information: Howard W. Zucker, D.D.S. Program Director, General Practice Dentistry Residency Wilmington Hospital, Room 2234 P.O. Box 1668 Wilmington, Delaware 19899
* Indicates required information
Name *
E-mail *
Phone *
Address
City
State
Zip
Date to begin	(mm/dd/yyyy)
Do you have the legal right to work in the United States? *	Yes No
If no, in what country do you have the legal right to work?
Military service *	Yes No
Eduation outside the United States? *	Yes No
Type of visa (if applicable)
Visa entry date	(mm/dd/yyyy)
Licensed to practice dentistry? *	Yes No
Licensed in what state, province or country?
Publications
Pre-dental school
Dates attended
Dental school
Dates attended
Internship
Internship dates
Residency
Residency dates