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  • Name: Aegd: Post-Graduate Student Checklist

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    The document lists the required paperwork and health assessments for post-graduate students at the College of Dental Medicine, including a personal information form, post-acceptance agreement, clinical privileges form, health assessment clearance, certificates for child abuse and infection control training, current CV, dental school diploma, training certificates if applicable, New York dental license, and visa information if not a US citizen.

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    Aegd Student Checklist(2)

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    The document lists the required paperwork and health assessments for post-graduate students at the College of Dental Medicine, including a personal information form, post-acceptance agreement, clinical privileges form, health assessment clearance, certificates for child abuse and infection control training, current CV, dental school diploma, training certificates if applicable, New York dental license, and visa information if not a US citizen.

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    34 views1 page

    Name: Aegd: Post-Graduate Student Checklist

    Uploaded by

    HomeBook
    The document lists the required paperwork and health assessments for post-graduate students at the College of Dental Medicine, including a personal information form, post-acceptance agreement, clinical privileges form, health assessment clearance, certificates for child abuse and infection control training, current CV, dental school diploma, training certificates if applicable, New York dental license, and visa information if not a US citizen.

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    of 1

    COLLEGE OF DENTAL MEDICINE

    Post-Graduate Student Checklist

    Name: _______________________________________________________________________ AEGD


    APPLICATION/Personal Information Data Form and
    Change of Address Form (Must contain NY area address and telephone)

    Signed Attestation (included on CD) Post-graduate Student Acceptance Agreement Delineation of Clinical Privileges Form
    Columbia University Health Care, Inc. (CUHC)

    Student Health Assessment Package


    (You will not be allowed to begin any clinical activity until you are cleared by Student Health Services)

    Certificate evidencing completion of Child Abuse Training


    (New York State Professional School exempt) Please log on to www.nysna,org or www.proceo.com to complete; there is a fee assessed for this course and the certificate is printed within minutes of completion

    Certificate evidencing completion of Infection Control Training


    (New York State Professional School exempt) Please log on to www.nysna,org or www.proceo.com to complete; there is a fee assessed for this course and the certificate is printed within minutes of completion

    Current CV
    (Current effective 7/1/06, i.e., must include all recent degrees, training and activity)

    Legible copy of Dental School Diploma AS APPLICABLE, attach legible copies of: Post-graduate training certificate(s) New York State Dental License and Current Registration Certificate Current Visa
    TYPE______________________________Expires____________________________

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