DMD Admissions Background Information Form (BIF)

Before completing the form fields below, please review our Background Check Policies and Procedures. You will also need to download, complete and sign these two documents, which you will attach at the bottom of this form along with a photo of yourself:

Dental Student Affairs Request for Background Information

Personal Data

Last Name *

First Name *

Pronouns *

Example: he/him/his

Preferred Name *

Specify the preferred first and last name for items like your name tag.

Name Pronunciation *

Please help us pronounce your name correctly by typing it out how it sounds.

Birthdate *

Birthdate: Year *

Birthdate: Month *

Birthdate: Day *

Birthplace *

Current Citizenship *

NON-U.S. CITIZEN ONLY: Specific Type of Visa

NON-U.S. CITIZEN ONLY: Visa Number

NON-U.S. CITIZEN ONLY: Visa Issuance Date(s)

Financial Status *

Residence

State of Legal Residence

KENTUCKY RESIDENTS ONLY: Indicate states and dates of residence for the past 5 years

KENTUCKY RESIDENTS ONLY: If you became a Kentucky resident within the last 10 years, for what reason did you move to Kentucky?

Employment

Please include start date and average hours worked per week.

Current Employer(s)

Military

Some types of military benefits may influence your residency status. Please provide additional information below.

Will you be using veteran's benefits to finance your dental school education? (This does not include the HPSP scholarship) *

If you selected yes, select the option(s) that applies to the benefits you will be using:

If other, please describe and be as specific as possible.

Disclosure Statement

The University of Louisville School of Dentistry requires all applicants who have received an offer of admission to submit to a background check through its approved vendor, Certiphi. All offers of admission are expressly conditional upon a satisfactory background check. Disclosing will not automatically disqualify your application, but failure to disclose may result in an offer being rescinded.

By checking this box, I indicate that I have read and understood the terms of the Criminal Background Check Policy and Procedures. *

Submission Attachments

Required documents listed below can be downloaded at the top of this form.

Interview Date

Interview Date: Year

Interview Date: Month

Interview Date: Day

Document #1: Minimum Technical Standards for Admissions and Matriculation *

One file only.
256 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Document #2: Liability Release *

One file only.
256 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Upload Personal Photo *

Upload a clear photo of yourself as a JPG (not HEIC or PNG). Please do not include other people in the photo. Maximum file size: 8 MB

One file only.
8 MB limit.
Allowed types: jpg, jpeg.

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

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