Schedule Now
Request an Appointment
woman dentist smiling

Apply for an Externship

Thank you for your interest in learning with Hudec Dental! The following documents are required to be signed and uploaded to your application: HIPAA Policy and Cell Phone Policy.

A signed copy of the Hepatitus B Acknowledgement and a copy of your Hepatitus B Vaccination record is also required to be emailed to recruiting@hudecdental.com in order for your application to be considered complete.

Important Note: The signer must be 18 years of age or older. If the participant is under 18 years of age, a parent or legal guardian is required to sign all applicable documents.

HIPAA Policy
Cell Phone Policy
Hep B Acknowledgement

Externship Application Form

"*" indicates required fields

Name*
Please enter a number from 0 to 500.
Please use the following format: mm/dd/yyyy
Requested Organization Location(s)*
Select between 1 and 3 choices.
Disclaimer: We will do our best to accommodate your requested organization location(s); however, placement at a preferred location cannot be guaranteed.
Accepted file types: pdf, Max. file size: 300 MB.
Please upload your signed copy of our HIPAA Policy as a PDF document.
Accepted file types: pdf, Max. file size: 300 MB.
Please upload your signed copy of our Cell Phone Policy as a PDF document.
Acknowledgement*