Student Guest Application

SFDS Student Guest Information Form
SFDS Board & Committees

Name

ADA Number

Mailing Address

Zip

Mobile Phone

Class of (year graduating)

School

UOP Dugoni School of Dentistry
UCSF School of Dentistry

Which SFDS Student Guest Opportunity Interests You?

Community Dental Health Committee (CDHC)
Legislative Committee (LegCom)
Member Engagement Committee (MEC)
Board of Directors (BOD)

What interests you most about participating as a guest on an SFDS Committee or Board of Directors?

How do you hope participation on this committee or board will support your education or professional career goals?

Are you willing to observe SFDS policies and guidelines, including maintaining the confidentiality of discussions?

Have you previously participated in organized dentistry activities (ASDA, CDA, ADA, community outreach, advocacy events, etc.)? If so, please briefly describe your involvement.

I understand the time required for this position and am willing to make this commitment if appointed.

Please check here

Date

SFDS

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