UCU Dental Camp

UCU Dental Camp
UCU Dental Camp

June 2024

Thank you for your interest in participating in a Uganda Christian University School of Dentistry Outreach Clinic!

If you have any questions, feel free to email: m.t.bartels@UgandaPartners.org

Each individual who would like to travel to Uganda for the Dental Outreach Clinic needs to fill out a separate application.

As part of your application, you will need to upload the following items using the form below. Please have these ready before you begin so you do not lose your progress.

Deposit Payment: This clinic is being done in conjunction with Uganda Christian University (UCU) and the US-based 501(c)(3) organization that supports UCU, Uganda Christian University Partners (Uganda Partners). In order to make your deposit payment of $250, use the link below.
https://app.etapestry.com/onlineforms/UgandaChristianUniversityPart/ucudental.html

Handbook: CLICK HERE TO DOWNLOAD HANDBOOK

This is the first dental clinic outreach that Uganda Christian Universtiy has done, so we are learning as we go. If you have any questions, please don't hesitate to email Mark Bartels at m.t.bartels@ugandapartners.org

Dentist Applicants:
- Photo of passport bio data page
- Resume or Curriculum Vitae
- Recent color passport size photograph
- Dental School Diploma
- Transcripts from Dental School
- Dental License
- Certificate of Good Standing from Dental Council
- Reference letter(s) from 3 professional associates
Note: If you have questions about any of the above requirements, please email: m.t.bartels@UgandaPartners.org.

Non-Dentist Applicants:
- Photo of passport bio data page
- Resume or Curriculum Vitae
Uganda Christian University will reach out to you via email with any questions or next steps regarding your application.

This camp is done to honor the memory of Logan Doseck.
First Name*
Last Name*
Email*
Phone*
Position Title*
Occupation*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Country*
Birthday*

MonthDayYear
Date
Sex/Gender*

MaleFemale
Have you ever been convicted of a felony?*

YesNo
If yes, please explain. (If no, write N/A.)*
Why do you want to come? What do you want to achieve?*
Upload Passport Bio Data Page:*

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Upload Resume or CV:*

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Upload recent color passport size photograph: (dentists only)

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Upload Dental School Diploma: (dentists only)

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Upload Transcripts from Dental School: (dentists only)

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Upload Dental License: (dentists only)

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Upload Certificate of Good Standing from Dental Council: (dentists only)

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Upload Reference letter(s) from 3 professional associates: (dentists only)

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Are there other things we should know? What comments/questions do you have?
By signing below, you affirm that the provided information is accurate and true to the best of your knowledge.
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Signature Date*

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Date
This clinic is being done in conjunction with Uganda Christian University (UCU) and the US-based 501(c)(3) organization that supports UCU, Uganda Christian University Partners (Uganda Partners).
After you submit, remember to make your deposit payment of $250, at the link below.

https://app.etapestry.com/onlineforms/UgandaChristianUniversityPart/ucudental.html
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