Mentoring Program Predental Student Mentee Form
This is the Predental Student Mentee questionnaire for the District 6 Mentor/Mentee Program. You must be an ASDA member to participate in this program. With the following questions, please answer as many or be as descriptive as you would like. We’ll be the similarities among these answers to pair up dental and predental students.

Please submit this form no later than November 13. Please, feel free to send this to anyone that might be interested in the program.

We will verify membership before sending out assignments. To join ASDA, please visit http://asdanet.org/joinnow.aspx. Joining ASDA as a predental member provides many benefits and resources, which you can take a look at here: http://asdanet.org/benefits/ and http://asdanet.org/predental/.
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First Name
Last Name
What is your current undergraduate institution? If you have graduated, please put your primary institution you attended.
State of undergraduate institution
Home state
Major and Minors
ex: Biology Major, Business Minor
Year of Undergraduate
Clear selection
Do you consider yourself a non-traditional student/applicant/re-applicant? Please specify with details as necessary.
Timeline/plan for dental school admissions
Clear selection
What field of dentistry interests you the most?
i.e. Academia/Academic Dentistry/Research/Teaching, Private Practice, Specialty, or other general interest
Which dental schools are you interested in applying to/learning more about?
What would you like to learn most about dental school?
What are some of your hobbies?
Describe a few volunteer, extracurricular, or leadership activities you been involved in.
Have you or are you currently involved in research? If yes, describe.
Email Address
Confirm Email Address
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