King’s College London
Association for Dental Education
in Europe
Dental Institute
Floor 18, Tower Wing
Guy’s Hospital
Great Maze Pond
London SE1 9RT
American Dental Education Association
655 K Street NW, Suite 800
Washington, DC 20001
www.adea.org
Dublin Dental University Hospital
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
Inter
The impact
Assessment
Networking:
professional
of new
in a global
the how and
Education:
technological
context
why for
an
and scientific
dental
imperative
discoveries
educators
for dental
on
education
traditional
dental
education
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
Shaping the Future of Dental Education: A Joint ADEA/ADEE initiative
Hosted by King’s College London 8th and 9th May 2017
King’s College London
American Dental Education Association
655 K Street NW, Suite 800
Washington, DC 20001
www.adea.org
Dental Institute
Floor 18, Tower Wing
Guy’s Hospital
Great Maze Pond
London SE1 9RT
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
20-25 25-30 30-35 35-40 40-45 45-50 50-55 55-60
range
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
Association for Dental Education
in Europe
Dublin Dental University Hospital
Trinity College
Dublin 2, D02 F859 Ireland
www.adee.org