University of Otago School of Dentistry - Faculty of Dentistry ...

University of Otago School of Dentistry
MASTERS DEGREES AND POSTGRADUATE DIPLOMAS
IN DENTISTRY APPLICATION FORM
PLEASE READ THE FOLLOWING NOTES CAREFULLY
International students please note that you must also fill in the international application form found at
http://www.otago.ac.nz/international/apply/index.html
Ensure all applicable sections are completed and questions answered legibly. All supporting documents must be
attached and correctly certified. Ensure your referees know the closing date (31 May) for their reports.
All applications must be accompanied by an up-to-date Curriculum Vitae. This must include: Name; Date of
birth; Present position and dates position held; Qualifications with dates of award and source; Previous
appointments and experience; Distinctions (such as prizes, scholarships); Details of any research activities,
publication, or scientific or clinical presentations; Memberships of professional organisations; Interests and
activities outside Dentistry.
All students applying for entry into the School of Dentistry must supply evidence of their immune status
for Hepatitis B (see attached document). This should be included with the application form, or forwarded
to the Secretary of the Faculty as soon as possible.
The minimum requirement for admission to a graduate course leading to the MDS or the MComDent is
normally an average B grade in the final year of the qualifying dental degree or an equivalent course.
Applicants who have degrees or diplomas awarded by institutions other than the University of Otago must send,
or arrange to have sent to the Secretary, Faculty of Dentistry, certified transcripts of their academic record
which must include the grades or marks awarded. Referees’ reports must be sent by the two referees directly to
the Secretary Faculty of Dentistry by the closing date. Forms for these reports are attached.
PROFICIENCY IN ENGLISH
All applicants who have not gained their Bachelor of Dental Surgery degree from the University of Otago or the
University of New Zealand must fulfil one of the following English requirements:
Either: TOEFL (Test of English as a Foreign Language) of 600 or better with a TOEFL TWE (Test of written
English) score of 5.0 or better, and a TOEFL TSE-A (Test of Spoken English) score of 5.5 or better.
Or:
Or:
IELTS (International English Testing System) of 7.5 (overall) with a score of 8 or better in the listening
band and 8 or better in the speaking band.
A pass in University of Otago English paper: ENGL 124 or an approved equivalent, including the oral
component.
Certified copies of relevant documents must be included with the application.
Applications close on 31 st May in the year preceding entry to a course.
All inquiries and applications should be addressed to: The Faculty Operations Manager
Faculty of Dentistry
PO Box 647
Dunedin 9054, New Zealand
Please ensure you have included the following where appropriate with your application
Evidence of Serum Hepatitis B/C status
Certified copy of passport documentation
Certified copies of academic transcripts
Curriculum Vitae
Certified copy of English language proficiency test
Names of your referees who will send references directly to the University
Letter of Good Standing from a Dental Registering Body with whom you hold current registration
OR Letter of Good Standing from the Dental Council of New Zealand confirming your current registration

PERSONAL DETAILS – ALL APPLICATIONS
Title
Family or Last Name
Given or First Name(s)
Address
Dr/ Mr/ Mrs/ Miss/ Ms
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Telephone Numbers ___________________ ___________________ __________________
(Work) (Home) (Fax)
Email Address
___________________________________
Date of Birth
___________________________________
Are you a New Zealand Citizen?
If not a New Zealand citizen do you have New Zealand Permanent Residence status?
Are you an Australian Citizen or permanent resident of Australia?
YES/ NO
YES/ NO
YES/ NO
If you are not a New Zealand citizen please attach certified copies of relevant passport entry, citizenship or visa
and explain your circumstances of entry to New Zealand.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Degree or Diploma for which application is being made (please tick):
Note: Please tick discipline of study. Only two options may be entered.
Degree of Master of Community Dentistry
Degree of Master of Dental Surgery in
Biomaterials Science
General Practice
Postgraduate Diploma in Community Dentistry
Postgraduate Diploma in Clinical Dentistry in
Endodontics
General Practice
Special Needs Dentistry
Oral Medicine
Oral Pathology
Oral Surgery
Paediatric Dentistry
Periodontology
Prosthodontics
{Please note: not all disciplines accept students every year)

Dental qualifications
First Degree or Diploma
College or University
Dates of attendance
Dates of graduation
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Postgraduate Degrees/Diplomas
College or University
Dates of attendance
Date of graduation
Where do you hold a licence to practise? _____________________________________________________
(A Letter of Good Standing is required from a body you are currently registered with)
Have you ever had a dental licence revoked? _________________ If yes, give reason:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

GENERAL INFORMATION – ALL APPLICANTS
(Use additional sheets if necessary)
1. Why do you wish to undertake this degree / diploma?
2. What do you plan to do following the completion of this degree / diploma?
3. How have you prepared yourself to undertake the course for which you have applied?

4. Give details of continuing education courses you have attended over the past 3 years.
5. Please give the names and addresses, phone and fax numbers of at least two people whom you have asked
to supply confidential references to support your application.

FURTHER INFORMATION FROM OVERSEAS APPLICANTS
IF YOU ARE NOT A NEW ZEALAND CITIZEN OR PERMANENT RESIDENT PLEASE
COMPLETE THE FOLLOWING:
1. Why do you wish to study in New Zealand?
2. Give a brief outline of how you will finance the period of study covering tuition fees, living and other
expenses. Give details of any scholarship, fellowship, grant or other aid that you have been awarded, or that
you have applied for, to assist you in your expenses for travel, accommodation, or study.

Have you included the following as required?:
* Evidence of Serum Hepatitis B/C status
* Certified copy of passport documentation
* Certified copies of academic transcripts
* Curriculum Vitae
* Certified copy of English language proficiency test
* Names of your referees who will send references directly to the University
* Letter of Good Standing from a Dental Registering Body with whom you hold current registration.
* Documents must be signed by a Notary Public or Justice of the Peace or equivalent.
Do you have any criminal convictions?
YES/NO
If YES please provide appropriate details in a separate envelope marked: confidential information
STUDENT DECLARATION
(PRIVACY ACT 1993)
I consent to the personal information which I have provided to the University being used for purposes
related to the matters in which I am involved in my capacity as a student and as required by protocols
between external agencies and the University. I understand that without this consent my enrolment
application cannot proceed.
I understand that information relevant to their duties may be used by:
Staff of Admissions, Enrolments, Examinations, Liaisons, Records, Library, Security, Student
Finances, Scholarships, Student Support Services;
Executive staff of the University Students’ Association
Assistant Vice-Chancellors and Deans;
Academic and administrative staff of the departments in which I am studying;
Ministry of Education (for statistical purposes, EFTS audit, administration of student loans and
allowances);
Student Loans Management Ltd, Ministry of Foreign Affairs & Trade, and Careers Service
Rapuara, tribal trusts and scholarship providers (where financial support is given by these
agencies);
Executive staff of any other tertiary institution to, or from which I am transferring or with which
the University has a conjoint teaching arrangement in which I participate.
Other agencies where disclosure is required for data matching or the maintenance of law and order
as defined in the Privacy Act 1993
I understand that I have the right to see and correct as necessary the information which I have provided.
Name:
Signature:
_________________________________________________
_________________________________________________
A false declaration may lead to exclusion from a course
I certify that the information I have provided in this application is true and correct
Signature: __________________________________________ Date: ______________________
* Make sure you have given the report forms to your referees

INFORMATION FOR INTENDING HEALTH PROFESSIONAL STUDENTS REGARDING HEPATITIS AND HIV-AIDS
All students applying for entry into the postgraduate dental programmes should supply evidence of their immunity status for
hepatitis B and C by the time they apply for admission. You must have the necessary blood tests done in time to ensure the
outcome can be submitted with your application for admission.
(This is a request for a current hepatitis status report from a registered medical practitioner - it is not a request for a letter
advising that you have been vaccinated or tested).
Because of the nature of their practice, health professionals are required to take steps to ensure they do not acquire infections from
their patients, nor transmit infections to patients. You are encouraged to discuss the content of this document with your medical
practitioner.
Hepatitis B
Hepatitis B is a common and often serious disease, with a high prevalence in New Zealand. For this reason, the Council of the
University has adopted, as part of its overall policy on transmissible major viral infections, recommendations about hepatitis B.
The following is a summary of the recommendations relevant to Health Sciences students:
1. Students contemplating enrolling in the postgraduate dental programmes must know their immune status for hepatitis B
before entering the course.
2. If you do not have this information, you must have the appropriate blood test. This test will indicate whether:
a) You have never been infected with the hepatitis B virus and have never been successfully vaccinated against
hepatitis B. In this case your blood will be hepatitis B surface antigen negative and hepatitis B surface antibody
negative; or
b) You have been infected with hepatitis B and have eliminated the infection, or been successfully vaccinated against
hepatitis B. Your blood will be hepatitis B surface antigen negative and hepatitis B surface antibody positive; or
c) You have been infected with hepatitis B and have failed to eliminate the infection. Your blood will be hepatitis B surface
antigen positive.
If results show you have never been infected or vaccinated, you are strongly advised to be vaccinated before entry. If you are
immune to hepatitis B you need to only submit your test results with your application.
If you are infected with hepatitis B and you wish to apply for admission to Dentistry you will be required to have further
specialised tests. If these tests show that you have detectable levels of hepatitis B viral DNA in your blood that exceed the
currently specified level, you will not be admitted to postgraduate programmes. If you have a low concentration of hepatitis B
virus in your blood, you can be considered for admission but will be required to seek counselling from the University’s Advisory
Panel about the ways to minimise any risk of transmitting the infection during your clinical training.
Hepatitis C
The University is reviewing the policy on admissions to Dentistry of students who have chronic hepatitis C infection. In the
interim, all students applying for admission to Dentistry must have a screening test for hepatitis C infection which, if positive, may
mean that they must also have confirmatory testing for hepatitis C antibody and hepatitis C RNA. Because of the possible longterm
prognosis for Hepatitis C sufferers, students being tested are advised to seek counselling.
HIV-AIDS
To summarise the current policy of the University, students who recognise they are at particular risk of HIV infection have a
responsibility to be tested for HIV infection. Students who test positive have a duty to seek and act on expert advice on
occupational matters which may affect them and their patients.
NOTE:
It is consistent with the policy of the Medical and Dental Councils of New Zealand, the Pharmaceutical Society and the Hospitals
in which students of this University gain their clinical experience. However, the University cannot guarantee that at some future
time one or more of these bodies may alter its policy in regard to these matters. If this were to happen, the University might no
longer be able to guarantee an infected person access to clinical training in order to complete the requirements of the course.
Registration
Registration is not essential for admission into Masters Programmes. Students may undertake concurrent registration
programmes. Enquiries regarding gaining registration to practise dentistry in New Zealand should be made to:
The Secretary
Dental Council of New Zealand
Level 8, The Terrace
PO Box 10-448
Wellington
Note: Holders of overseas degrees should enquire with the Dental Council whether or not their degree is acceptable for
registration to practise in New Zealand. Moreover, attaining higher degrees in Dentistry in New Zealand will not
automatically qualify international applicants to practise in New Zealand.

REFEREES REPORT – MAY BE SENT ELECTRONICALLY
Application for Postgraduate Course at University of Otago School of Dentistry
Referees are asked to complete the reference form or to cover the areas mentioned in a letter.
The report should be directly sent to:
The Faculty Operations Manager
Faculty of Dentistry
PO Box 647 Tel: +64 (3) 479 7037
Dunedin 9054 Fax: +64 (3) 479 7677
New Zealand
Email: margaret.berkeley@dent.otago.ac.nz
By 31 May
Name of Applicant ............................................................................................................
Course Applying for ............................................................................................................
Name of Referee ............................................................................................................
Position ............................................................................................................
Address ............................................................................................................
Phone .............................. Fax .............................. Email ........................................
How long have you been known to the applicant?
In what capacity do you know the applicant?

Please comment on the following:
Relevant Educational and Postgraduate Experience:
How would you rank this candidate’s suitability to undertake Postgraduate Training?
(Please rank in comparison to peers.)
Comments:
Top 10%
Top 30%
Above 50%
Below 50%

Applicant’s personal qualities, characteristics and attributes relevant to the course of study:
Other comments that would be helpful in supporting the applicant:
Signature ...................................................... Date ......................................................