Impact Application

Fill out this form to apply for free tuition to Impact for dental students and first year grads. We want to know how you are making or planning to make an Impact in Dentistry!

Name

First Name

Last Name

Phone

(###)

###

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Tell us little about yourself.

What drew you into dentistry?

How do you want to make an impact in dentistry?

What is the biggest challenge you have faced being a woman in dentistry and how have you or are you hoping to overcome it?

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