Summer Student Practitioner Program

Dentist Mentor Application Form

Thank you for your interest in the Summer Student Practitioner Program. Since 1982, BC dentists and selected UBC dental students have participated in this mutually beneficial program, which has been approved by the College of Dental Surgeons of British Columbia. The summer student program provides incoming Year 4 dental students with an opportunity to be part of the day-to-day operation of a dental practice and it is open to students who have successfully completed their Year 3 DMD studies.

We have received funding from the PDC Trust and CDSPI to provide assistance with travel and cost of living expenses for students who wish to participate in a rural practice setting. We are currently seeking expressions of interest from dentists in rural areas of BC. In order to facilitate student matches, we are asking interested dentists to tell us a little about their practices and location.

  Yes, our office would like to be involved in the Summer Student Practitioner Program.

 Last Name: 
 First Name: 
 CDSBC Registration Number: 
 
Address
 Address (line 1): 
 Address (line 2): 
 City: 
 Province: 
 Postal Code: 
 
Phone and Email
 Phone Number: 
Fax Number: 
 Email Address: 
 
 Summer of 
 Dates available: 
(Students can participate after the first week of July until the third week of August)
 
 Check the one that applies:  I would like to be matched with a UBC Dentistry student.
I have already invited a UBC Dentistry student to work with me during the summer.
 Student's Name: 
 
 If you are in outside the Lower Mainland, will room and board be included?  Yes   No
 If yes, will the student be expected to pay for room and board?  Yes   No
 
 Please tell us about your practice:
(e.g. type of care, number of patients/staff, number of operatories, etc.):
  
 
 Please tell us about your geographic location:
(e.g. recreational facilities,
population, accessibility, etc.):
  
 
If you have any questions, please contact Student Services at 604-822-7977 / fodss@dentistry.ubc.ca