** Please print on your University Letterhead **
Dean’s Reference Letter
To be Completed by Applicant:
I, Dr. __________________________________________________, who graduated in Dentistry from
(Please Print)
_______________________________ in ______________________, am applying for admission to the
(University)
(City/Country)
Graduate Program in Oral and Maxillofacial Surgery at the University of Manitoba, and I authorize
the release of information regarding my Undergraduate Dental School performance.
Signed by Applicant: ________________________________ Date: ______/______/_______
(mm/dd/year)
To be Completed by Dean:
Please provide the following information:
1. The applicant’s class standing(or ranking) for the final year of the program: _______________
2. Where would this applicant rank if he/she applied for graduate training in a clinical specialty, at
your institution?
a. Would be a highly desirable applicant
b. Would be considered, but an average applicant
c. Would not be considered
3. How was this student with their administrative responsibilities during their undergraduate
education? (eg. Did they do their charts on time? Was student on time for clinic?)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
4. Other pertinent information (e.g. Awards received):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
MAIL TO:
Admissions - Faculty of
___________________________________ _________________________________
Graduate Studies
Name of Dean / University
Signature
Rm 500
Please Print
University Centre
Winnipeg, MB R3E 2N2
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