Student

Student Membership is open to individuals enrolled full-time in a CODA-accredited predoctoral, graduate, or postgraduate dental program, or in an accredited dental technology program, or an international equivalent. Student Members enjoy access to educational resources and selected committee opportunities but are not eligible to vote or serve as directors, officers, or committee chairs. Annual dues apply as determined by the Board.

First Name

Last Name

Address

City

State/Province

Zip / Postal Code

Country

E-mail

Phone

Institution & Program

Expected Graduation Date

Proof of Full-Time Enrollment

Program Director Verification

By submitting this application, I support the Purpose of the Academy, agree to follow all Bylaws and policies, and certify all information is accurate.

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