Dentistry Request for Reference Letter

Fields denoted by an asterisk (*) are required.

Name of Student/Graduate Name of Student/Graduate First Last
Student’s Email Address
Student’s D.D.S. Graduation Year (e.g. Class of 2024)
Type of Reference Requested:
Forms for Signature

You must complete all of your personal information on the form before uploading it for signature.
Institutional instructions regarding student application process not required.
Please indicate the "other" reference type:
Name of Institution
To the Attention of:
Address of School/Institution (the institution to receive the letter/document, not your own address Address of School/Institution (the institution to receive the letter/document, not your own address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email Address of Contact/Institution/Department to receive the reference (not your email)
Upload existing form for signature

Attach Files
Do you require a 2nd letter?

Do you require a 2nd letter? Yes No
Type of Reference Requested (2nd letter):
Please indicate the "other" reference type (2nd letter):
Name of Institution (2nd letter)
To the Attention of (2nd letter):
Address of School/Institution (the institution to receive the letter/document, not your own address) (2nd letter) Address of School/Institution (the institution to receive the letter/document, not your own address) (2nd letter)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email Address of Contact/Institution/Department to receive the reference (not your email) - 2nd letter
Do you require a 3rd letter?

Do you require a 3rd letter? Yes No
Type of Reference Requested (3rd letter):
Please indicate the "other" reference type (3rd letter):
Name of Institution (3rd letter)
To the Attention of (3rd letter):
Address of School/Institution (the institution to receive the letter/document, not your own address) - 3rd letter Address of School/Institution (the institution to receive the letter/document, not your own address) - 3rd letter
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email Address of Contact/Institution/Department to receive the reference (not your email) - 3rd letter
Do you require a 4th letter?

Do you require a 4th letter? Yes No
Type of Reference Requested (4th letter):
Please indicate the "other" reference type (4th letter):
Due Date of Reference (4th letter) Due Date of Reference (4th letter) / MM / DD YYYY
Name of Institution (4th letter)
To the Attention of (4th letter):
Address of Institution (4th letter) Address of Institution (4th letter)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Do you require a 5th letter?

Do you require a 5th letter? Yes No
Type of Reference Requested (5th letter):
Please indicate the "other" reference type (5th letter):
Due Date of Reference (5th letter) Due Date of Reference (5th letter) / MM / DD YYYY
Name of Institution (5th letter)
To the Attention of (5th letter):
Address of Institution (5th letter) Address of Institution (5th letter)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Online Evaluation - Attach a link here

(this does not apply to ADEA PASS. ADEA notifies the school directly once an account is created)
Online Evaluation - Attach a link here (2nd letter)

(this does not apply to ADEA PASS. ADEA notifies the school directly once an account is created)
Online Evaluation - Attach a link here (3rd letter)

(this does not apply to ADEA PASS. ADEA notifies the school directly once an account is created)
Upload GPR/OMFS Applicant Information Forms Here if Necessary

Attach Files
Deadline for Schulich Dentistry (not the final application deadline)
(allowing at least three weeks notice) Last minute requests may not be accommodated. Deadline for Schulich Dentistry (not the final application deadline)
(allowing at least three weeks notice) Last minute requests may not be accommodated. / MM / DD YYYY

As previously noted at the top of this webpage, and via communications from the Office of Dental Education, at least three weeks notice is required for the process of facilitating academic references.
Deadline for Schulich Dentistry
(allowing at least three weeks notice) Last minute requests may not be accommodated.
(2nd letter) Deadline for Schulich Dentistry
(allowing at least three weeks notice) Last minute requests may not be accommodated.
(2nd letter) / MM / DD YYYY

As previously noted at the top of this webpage, and via communications from the Office of Dental Education, at least three weeks notice is required for the process of facilitating academic references.
Deadline for Schulich Dentistry
(allowing at least three weeks notice) Last minute requests may not be accommodated.
(3rd letter) Deadline for Schulich Dentistry
(allowing at least three weeks notice) Last minute requests may not be accommodated.
(3rd letter) / MM / DD YYYY

As previously noted at the top of this webpage, and via communications from the Office of Dental Education, at least three weeks notice is required for the process of facilitating academic references.
Additional Information

Dentistry Request for Reference Letter

Dentistry Request for Reference Letter

Forms for Signature