Name * Street Address * City/State/Zip Code * Phone Email * College/University Graduation Year Dental School * Expected Date of Graduation * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year201720182019202020212022 Year Present Class Rank Class Rank Number in Class Class Year National Board of Examiners Part I (average) References Reference 1 Reference 2 Rank Order of Preferred Externship Dates Typically in two week blocks Preferred Date 1 Preferred Date 2 Preferred Date 3 Preferred Date 4 Statement * Upload Please submit a statement of why you wish to pursue an externship in Oral and Maxillofacial Surgery (100 words or less).Files must be less than 2 MB.Allowed file types: txt pdf doc docx. Please direct further inquiries to omfs-program@osu.edu. Leave this field blank Submit
