2022-23 ADEA AADSAS Fee Assistance Program (FAP) Application and Submission Form

Welcome 2022-23 ADEA AADSAS Fee Assistance Program (FAP) Application and Submission Form
Thank you for your interest in applying to the ADEA AADSAS Fee Assistance program. ADEA is pleased to offer this opportunity to applicants who are experiencing extreme financial hardship to assist them in their endeavor of becoming a dentist. Please note it is important to read all ADEA AADSAS FAP instructions carefully prior to completing this application.
Have you created an ADEA AADSAS account? *

Yes No
You must create an ADEA AADSAS account to receive your CAS ID# before continuing.
Have you read all of the ADEA AADSAS FAP instructions? *

Yes No
ADEA AADSAS FAP encourage all applicants to read all of the ADEA AADSAS instructions before completing the application and submission form. Applicants will have only ONE chance to submit the ADEA AADSAS FAP Application and Submission Form and all required supporting documents.
Do you understand that there will be only one opportunity to submit the FAP Application and Submission Form along with all required supporting documents? *

Yes No
You will have only one opportunity to submit the ADEA AADSAS FAP Application and Submission form and all required supporting documents.
By clicking 'I agree' you are indicating that you have read and understand the instructions for applying to the ADEA AADSAS Fee Assistance Program. This includes that:
- You will have only ONE chance to submit your information and supporting materials.
- Once an application has been submitted you cannot add any additional information to the application.
- Once you start the application you cannot save and come back later to complete. It must be completed in one sitting.
Are you a U.S. Citizen, Permanent resident (also known as a green card holder) or have Deferred Action for Childhood Arrivals (DACA) status? *

Yes No
You do not qualify for the ADEA AADSAS Fee Assistance Program.

Biological Information
Date

Month Day Year
First Name *
Last Name *
What is your preferred pronoun? *

She, Her, Hers He, Him, His
ADEA AADSAS CAS ID: *
The ADEA AADSAS CAS ID is 10 digits. Do not use the ADA DENTPIN!
ADEA AADSAS CAS ID-NEW: *
The ADEA AADSAS CAS ID is 10 digits. Do not use the ADEA DENTPIN!
Email Address *

Confirmation Email (You will receive the FAP decision at this email address)
Are you 26 years of age or younger, born after January 1, 1995? *

Yes No
Date of Birth: *

Month Day Year

Submission
File Upload Information

All required supporting documents must be combined into one PDF file. Create a PDF of each file that will be submitted and then combine into one document. Not sure how to do this? Check out the resources below.
File Upload *
Maximum file size is capped at 100MB. Only one file can be uploaded.
Type your name below to certify that all information is complete and correct. This will create an electronic signature.
Your Name *

First Name Last Name
Your Signature:

{yourName}
Date: *

Month Day Year
Note: If you purposely give false or misleading information on this document, you will be disqualified from receiving funds and any previous funds awarded may be rescinded.
Please verify that you are human *
* * * BEFORE YOU CLICK "SUBMIT" * * *

Are you submitting all required supporting documents? Failure to provide all required supporting documents at the time of submission of the ADEA AADSAS Application and Submission form will result in automatic denial of your request for fee assistance. You will only have one opportunity to submit all required supporting documents.

DID YOU UPLOAD YOUR W2 AND TAX RETURN?

IF NOT, EITHER GO BACK AND ADD TO YOUR PDF OR GIVE EXPLANATION IN THE MISSING DOCUMENTATION BOX.

Press the button below to review your answers.
AMERICAN DENTAL EDUCATION ASSOCIATION
Should be Empty:

Biological Information

Applicant Financial Information

Parental and Other Financial Information

Submission