2021-2022 ASDA District 4 Pre-Dental Mentors

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Thank you for your interest in serving as a mentor to future dental students!

Mentors are the most valuable predental asset to our district 4 meeting and you have an opportunity to give guidance to our future colleagues. There are limited spots, so sign up soon. More details to come soon as we gather interested mentees and pair you guys up.

Application Deadline: October 15, 2021

If you have any questions, feel free to email our ASDA D4 Predental Chair, Natalia Chavez Choque at chavezchoqunc@vcu.edu.

First and Last Name *

Pronouns *

She/her/hers

He/him/his

They/them/theirs

Prefer not to say

Ethnicity/Race *

White

African American

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

Asian

Hispanic/Latinx

Other:

Required

Email Address *

Phone number *

Year *

What dental school do you attend? *

UTHSC

ECU

UNC

Meharry

MUSC

DCG

VCU

Undergraduate institution & graduation year *

Did you take a gap year?

Yes

Clear selection

What are some of your interests in dentistry and plans after graduation? *

What are your hobbies/passions?

On a scale of 1 to 10 (1 being introvert, and 10 being extrovert), where do you fall?

Introvert

Extrovert

Clear selection

Briefly describe why you want to become a mentor. *

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