Reflection Paper and Credit Time Form

Please Fill In The Appropriate Information. When Finished Please Click The Submit Button.

*denotes required field


*First Name *Last Name *Email Address
*Student ID *Contact Number

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*Purpose of Event

*How many times did you participate in community service as a:




*What specific skills did you use at your community site that created a positive immediate outcome? (check all that apply)
Verbal Communication
Non-Verbal Communication
Clinical Knowledge
Academic Knowledge
Team building
How will the outreach you provided positively change the long term personal oral health behavior of the population?
If you experienced any challenges working with a diverse population, what were the challenges?
If you experienced any challenges with this particular community service activity, what were the challenges?
Based on your experience, what will you change next time?
Do you think the community service you provided is an effective approach to educating the community about oral health?

If you are a sophomore, junior, or senior, has your professional values and beliefs about community service changed from your freshman year?

Compared to when you entered dental school as a freshman, how would you now describe your community service commitment?

Seniors only: Has your personal opinion and beliefs about the effectiveness of community service changed since freshman year?

Seniors only: Are you committed to providing community service after graduation?

*Time Spent at Event