2008 UCSF DENTAL SCHOOL SECONDARY APPLICATION INSTRUCTION SHEET

Our records indicate that your AADSAS application has been received by our office and that you meet our
minimum eligibility requirements. Your application is now eligible for further review by the Admissions
Committee. This requires that you submit the following secondary application. The secondary application
must be received in our office no later than 4 weeks from the date you were invited to submit it. Please
read and adhere to the following instructions carefully:
1. You must complete and return all forms included in this application along with the required application fee or fee
waiver.
2. You should complete these forms on your computer and then print them for signing and mailing.
3. You must use the forms provided and your replies must fit in the space provided. Do not include any additional
materials or pages. Any such materials received will be discarded and will not be included in your application
folder.
4. Do not attempt to adjust the font or type size in the forms. This has been set for consistency. Any attempt to
change the font or type size could result in your application being canceled for failing to adhere to the guidelines
provided.
Completing the forms:
1. After you have completed the General UCSF application (labeled Type D), print and sign two copies. Mail one
copy, along with the appropriate application fee ($60 for US citizens and permanent residents, $80 for all others,
payable to UC Regents), to:
UCSF Admission & Registrar
File # 307902
PO Box 60000
San Francisco CA 94160
Do not send any transcripts, letters of recommendation, other documents or correspondence to this address.
2. Mail the signed second copy along with Secondary Application forms A, B and C to:
UCSF School of Dentistry
Office of Admissions
513 Parnassus Ave., S-619
San Francisco, CA 94143-0430
3. Form A: Proposed Course Schedule. Use this form to account for all of your prerequisites whether completed,
in progress or planned. All prerequisites must be completed no later than the end of the spring 2008 term. This
form is used to verify your eligibility for admission so failure to complete it in its entirety could result in your
application being canceled.
4. Form B: Background Information. This form is intended to provide the Admissions Committee with more
information than is available from your AADSAS application. Please fill it out as completely as possible.
a. DDS/PhD Program. If you are interested in applying to the DDS/PhD program, you must also meet all of the
following conditions:
i. Have a minimum science GPA of 3.20
ii. Submit official GRE scores before February 1, 2008
iii. Have experience in a research lab or some exposure to research methods
iv. A letter of recommendation from a laboratory scientist or principle investigator (Note: this counts as one of
your three allowed letters of recommendation)
5. Form C: Supplementary Questions. Your replies to these questions will help us better evaluate your
preparation for dental school. You may only use the space provided to answer these questions. Please avoid
repeating information already outlined in your AADSAS personal statement.
6. Submitting a high school transcript. In some instances applicants must submit a high school transcript as part
of the application process. Please answer the following questions to determine if you must submit a high school
transcript.

a. As of October 15, 2007 have you been awarded a Bachelors degree?

Yes
Stop. You do not need to submit a high school transcript.

No

Continue to the next question.

b. Have you completed at least one regular full-time term at a University of California campus [this does not
include University Extension or summer session. This also does not include California State University (CSU)
campuses]?
Yes
Stop. You do not need to submit a high school transcript.

No

c.

Continue to the next question.

Did you attend high school in the United States?

Yes

You must submit an official high school transcript. This transcript must be received by our office no later than
February 1, 2008.

No

You do not have to submit a high school transcript.

6. Secondary Application Fee Waiver. A limited number of fee waivers for the secondary application fee are
available for U.S. citizens and permanent residents. If you meet the income criteria outlined in the table below,
contact admissions@dentistry.ucsf.edu and request to be sent a fee waiver application. In this instance, disregard
instruction #1 above. Instead, send both copies of the UCSF General Application form with your Secondary
Application to the address listed in instruction #2 and include both the completed fee waiver application and a
check for $60 payable to the "UC Regents." If the fee waiver application is approved, the check will be voided. If
the fee waiver application is not approved, the check will be submitted for payment.

Type: D

2008 DDS APPLICATION

University of California

Copy I

Specialty(check one)

San Francisco

Prosthodontics

Oral Pathology

General Practice Residency

Oral and Maxillofacial Surgery

Before completing this application please read the back of the form. Sections 1, 2, 3 and 5 must be completed.
1. PERSONAL INFORMATION
Please print or type your legal name as it should appear on all
official University records and sign it in the same way.
NAME

First Name

Last Name

CURRENT
ADDRESS

Former Name(s)

TELEPHONE (

Apt #

City

PERMANENT
ADDRESS

Middle Name

Street Address

(Daytime)
State

County

Country (if not U.S.)

TELEPHONE (
Street Address

Please do not write

in the space below.
For Office of
Admission and
Registrar use only.

SOCIAL SECURITY NUMBER

gen
eth

Zip

cob

Apt #

lob
City

County

Country (if not U.S.)

State

E-MAIL
ADDRESS

TELEPHONE (

Zip

pre

res

(Evening)

cit

2 . RESIDENCY INFORMATION
BIRTHPLACE

vis

BIRTHDATE
City

State

VISA

CITIZENSHIP
Country of Citizenship

Country (if not U.S.)

wnt

If you are not a U.S. citizen, what type of visa do you have?
J-1
F-1
Permanent Resident Status
Other: Specify

STATE RESIDENCE
Are you a legal resident of California?

Yes

No

Give place and date of previous permanent residence

3 . EDUCATIONALBACKGROUND

sum

If you have moved to California, when did your present stay begin?
(Month - Day - Year)
City

State

spr

Dates

Country

Chg
Sch
Deg
Yr

List in chronological order all colleges ever attended. Include all schools you are now attending. List

additional schools on separate page.

University/Instution Name

4. STATISTICALINFORMATION
Ethnicity
(A)
(B)
(C)
(D)
(F)
(G)
(H)

Attendance
From: mm/yy
To: mm/yy

Location

Degree

Major

Date Received
or Expected

(Providing this information is voluntary, please see reverse side.)

Check One:

American Indian/Alaskan Native*

Black/Afro-American
Chicano/Mexican-American
Chinese/Chinese-American
East Indian/Pakistani
Japanese/Japanese-American
Korean/Korean-American
*See reverse side for more information

(J)
(L)
(M)
(N)
(P)
(Q)
(V)
(K)

Latino/Other Spanish-American*
Pilipino/Filipino
Pacific Islander*
Other Asian*
White/Caucasian*
Middle Eastern/North African
Vietnamese/Vietnamese-American
Other, Please specify

5. SIGNATURE
I certify that I have carefully considered each question and that my statements are true and complete
to the best of my knowledge. Further, I understand that cancellation of my admission privileges may
result if any information is found to be incomplete or inaccurate.

Applicants Signature

Date

SEX
Male
Female

For information regarding Services to

Students with Disabilities, please read the
back of this form. Also note that it is the
student's responsibility to identify himself/
herself in a timely manner to the Office of
Student Relations in order to receive
accommodations necessary to allow the
student to complete the academic program to
which he/she has been admitted.
6/05

UCSF School of Dentistry Secondary Application

Last Name

Form A: Proposed Course Schedule

First Name

MI

Social Security Number

AADSAS ID

Instructions: Complete this form to account for all course work you will be taking during this current academic year. You
must also account for all prerequisites in the second table. List all units in quarter units. 1 semester unit = 1.5 quarter units.
School:
Dept/Course #

Summer 2007
Course Title

Units

School:
Dept/Course #

Fall 2007
Course Title

Total
School:
Dept/Course #

Units

Total
Winter 2008

Course Title

Units

School:
Dept/Course #

Spring 2008
Course Title

Total

Units

Total

Dental Prerequisites

Course #

Grade

Qtr Units

School

Term

Year

Sample Course
General Chemistry w/ Lab

Biol 150

A-

4.5

UC Berkeley

Wi

2007

(2 semesters or 3 quarters)

Organic Chemistry w/ Lab

(1 semester or 2 quarters)

General Biology/Zoology w/ Lab

(2 semesters or 3 quarters) Note: Anatomy

and Physiology will not fulfill this requirement

General Physics w/ Lab

(2 semesters or 3 quarters)

Biochemistry (4 qtr units)

Psychology (1 semester or quarter)
English Literature and Composition
(2 semesters or 3 quarters)

IP or
Planned

UCSF School of Dentistry Secondary Application

Last Name

Form B: Background Information

First Name

MI

Social Security Number

Are you a reapplicant? ( A reapplicant is defined as someone who has applied to our program during
one of the two previous application cycles)

No

Yes
Yes

Are you interested in the DDS/PhD program? (See instructions for minimum eligibility requirements)
List who your 3 recommendations are from:

AADSAS ID

No

2006 Application Cycle

2007 Application Cycle

Yes

1.
2.
3.

(Additional letters will be discarded)

The following information addresses your familys living situation and education. It form is designed to provide biographical and
demographic information that will help us assess your past and present socioeconomic circumstances. All information requested is
essential and will be kept confidential.
Your Age:
1. Type of community (Check all that apply):
Urban
Suburban
Reservation
Rural or Farming
Inner City
Other (define)

1 5 years

6 11 years

12 17 years

18 years to present

2. Housing/Residence (Check all that apply):

Public or Subsidized
Rented by Family
Owned by Family
3. Parents Marital Status (indicate if married, divorced,
remarried, single, widowed):
4. Predominant Language Spoken in the Home:
5. Household Employment (Full-Time, Part-Time, Disabled, Unemployed, Social Security, Retired):
Father/Legal Guardian
Mother/Legal Guardian
Spouse (if applicable)
Self
6. Education of Household (Indicate Highest Level):
Father/Legal Guardian
Mother/Legal Guardian
Spouse (if applicable)
7. Self and Spouse Employment and Financial History [Please list any full-time or significant employment for you or your spouse (if
applicable) including dates and salaries - attach additional pages if necessary]

Statement of Authenticity: I certify that the information submitted on this form is true and correct. I agree to provide, if requested, any official documentation necessary to verify this
information. I understand that false statements or misrepresentation on this form may result in an admission offer (if offered) to the University of California, San Francisco being revoked.
I also consent to any investigation for clarification or verification of the information provided.
Signature

Date

UCSF School of Dentistry Secondary Application

Last Name

First Name

Form C, page 1: Supplementary Questions

MI

Social Security Number

AADSAS ID

Please answer the following questions using only the space provided. Questions 1-6 are required of all
applicants. Questions 7 and 8 are optional/conditional (see below). Do not use any special formatting such as
bold, italics, or underlining.
1. Describe any practical or observational experience (paid or voluntary), including the amount of time spent, that you
have had in the dental/health care field. What have you learned from this experience? How did it reinforce your
career choice?

2. Describe any barriers you have had to overcome in achieving your educational objectives and how you overcame
these barriers. These could include any or all of the following: educational and economic barriers, or other hardships
that you have overcome.

UCSF School of Dentistry Secondary Application

Last Name

First Name

Form C, page 2: Supplementary Questions

MI

Social Security Number

AADSAS ID

3. Discuss one activity or experience you listed in your AADSAS application as a means of providing evidence of your
leadership skills or self-initiative.

4. Discuss your contributions to your community. Focus on any special skills or insight you have gained or developed,
and how this will influence your future practice as a dentist.

UCSF School of Dentistry Secondary Application

Last Name

First Name

Form C, page 3: Supplementary Questions

MI

Social Security Number

AADSAS ID

5. Are you proficient in any language other than English (either written or spoken)?

6. Please state briefly why you should be chosen for admission to the UCSF School of Dentistry over other applicants
with similar experiences and qualifications.

7. (Optional) Please use this space to tell us anything additional that you believe is relevant to your application for
admission.

8. (Conditional) Re-applicants should use the following space to detail what steps they have taken since their last
application to make themselves a more competitive applicant. All others should leave this space blank.