POST-DOCTORAL PERIODONTICS
Medical University of South Carolina
Application for Admission
To Begin July 1, 2015
I.
INSTRUCTIONS FOR APPLICANT
A.
TYPE OR PRINT ALL INFORMATION. Applications may be submitted at any time before the application
deadline of August 1, 2014. Application as early as possible is strongly recommended. We invite
qualified applicants for personal interviews and extend offers to our future residents in accord with the
Periodontal Resident Recruitment Guidelines developed by the American Academy of Periodontology
and adopted by the majority of university based post-doctoral Periodontics programs. These Guidelines
may be accessed at http://perio.org/education/resident-recruitment.htm
B.
Request the authorities of your college and dental school to submit an OFFICIAL transcript of your
record. It is your responsibility to assure that all transcripts are sent and received.
C.
Request letters of recommendation from three members of the faculty at your dental school and/or
practicing dentists attesting to your character and abilities. One of these letters MUST be from a faculty
member of the Department of Periodontics of your dental school.
D.
Please send ALL transcripts, letters of recommendation, National Board Examination scores, Graduate
Record Examination scores (only if applying to M.S. degree program), this completed application and a
recent mounted photograph to:
Dr. Joe W. Krayer
Director, Post-Doctoral Periodontics
College of Dental Medicine
Medical University of South Carolina
173 Ashley Avenue
119 BSB MSC 507
Charleston, South Carolina 29425
II.
Communications
Phone:
(843) 792-3907
Fax:
(843) 792-7809
E-Mail:
krayer@musc.edu
PERSONAL DATA
A.
Name
Last
First
Place a
recent
photograph
in
this space
Middle
Page 2
B.
Present Mailing Address
Street
City
Apartment No.
State
Area Code – Telephone
Zip
Cell Phone (if available)
email address (if available)
After you submit this application please notify us of any change in your contact information including
mailing address, phone number, cell phone number and email address.
C.
Present School or Office Address
Street
City
D.
State
Zip
Area Code - Telephone
Name and Address of Parent or Closest Relative
Last
City
State
E.
Place of Birth
F.
State of Legal Residence
First
Zip
Area Code - Telephone
Citizenship (Country)
Status if not US citizen
III.
STATE LICENSURE
None
State / Number
State / Number
/
IV.
/
State / Number
State / Number
/
/
Dates Attended
(Month/Year)
Degree
Conferred
EDUCATION (List all colleges and universities attended)
Name of Institution
City, State
to
to
to
to
V.
If you graduated from dental school more than six months ago, briefly describe how and where
you have spent your time since graduating.
Page 3
VI.
Have you ever made an application to this institution before?
 No  Yes
If yes, when?
/
Month
VII.
Which college?
Year
Scores from Part I of the National Dental Board Examination are required for application
to the program and must be sent to us as part of your application package.
Scores from Part II of the National Dental Board Examination must be sent to us as soon as
they are available.
VIII.
Have you taken and completed the Graduate Record Examination (GRE) which is required
for admission to the basic sciences M.S. degree program?

I do not plan on taking the GRE

No, but I anticipate completing the GRE by
/
Month

Yes
Date
Month
IX.
Year
/
Year
Names and addresses of the three persons from whom you have requested letters of
reference:
Name
Address
A.
email address
phone number
B.
email address
phone number
C.
email address
phone number
X.
Please attach a brief narrative describing your motivation to pursue post-doctoral training in
Periodontics and outline your career goals. Include whether you are interested in pursuing the
Master of Science in Dentistry (M.S.D.) or the Master of Science degree (M.S.) in a basic
science.
Page 4
Signature of Applicant
Date of Application
The Medical University of South Carolina does not discriminate on the basis of race, creed, national origin, sex, age, or
handicap, in the recruitment and admission of students, employment of faculty and staff, and the operation of other
educational activities and programs, as specified by federal laws and regulations; Title VI of the Civil Rights Act of 1964,
Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination
Act of 1975.
DIVISION OF PERIODONTICS - DEPARTMENT OF STOMATOLOGY
Revised – February 10, 2014