IUSD Graduate Admissions Supplemental Questions


Please answer the following questions:

Name ________________________________________________

Program of Interest ______________________________________

List honors and awards received in college and dental school

List professional organizations in which you hold membership

List military service (previous or current)

List private practice, research, teaching and/or work experience

Have you ever been subject to disciplinary action by any college or university in connection with your academic performance?     
Yes ______        No _______

If you answered yes to the previous question, enter an explanation regarding each such discipinary action.  Include 1) a brief description of the incident that was the basis for the disciplinary action, 2) the specific change(s) made, 3) the disciplinary action taken, and 4) a reflection on the experience and how the experience has affected your life.

Have you every been subject to disciplinary action by an college of university in connection with your conduct or behavior?   
Yes ______       No _________

If you answered yes to the previous question, enter an explanation regarding each such disciplinary action.  Include 1) a brief description of the incident that was the basis for the disciplinary action, 2) the specific change(s) made, 3) the disciplinary action taken, and 4) a reflection on the experience and how the experience has affected your life.

NOTE:  Applicants are required to disclose all information relating to any disciplinary action whether it resulted in a sanction or not.  If you are not certain whether you have been subject to any disciplinary action, contact the registrar, student affairs officer, or other appropriate individual at the applicable college of university to confirm.   Applicants have a continuing obligation to disclose all disciplinary history (whether final or not) prior to actual enrollment in the Indiana University School of Dentistry.  Failure to disclose will result in further investigation and may lead to withdrawal of admission or other sanction.