Form

Externship Request

55 Jaidev Road St. Johns, FL 32259 T: 904.201.6000 F: 904.201.6004

Office Name

Doctor Name

Dear Doctor,

Thank you for your interest in becoming an adjunct faculty for the Bartram Dental Assisting School. This is an important part of our students’ training and is required for their graduation. To complete the course and graduate, the student is required to extern in a dental office for at least 60 hours. They may begin their externship upon completion of their coursework.

It is necessary for the student to have ample work experience with the doctor and with patients to gain the confidence they need to find a job after their externship. The doctor must ensure that the student is actively working with patients, and completing all procedures on their externship evaluation form. If you prefer that they do not perform certain procedures with patients, you may have them observe you and your team, but we highly encourage their active participation.

While we realize that the student will work with many members of your team during their experience, we have found that it works best if one team member is assigned to the student as a mentor in addition to the doctor. The mentor will help oversee the daily activities, be the main point of contact for the school, be responsible for evaluations, etc. If well organized, mentoring only takes minutes a day, while at the same time gaining the services of a student’s accumulated abilities. Mentors must fill out the Voluntary Adjunct Faculty Application and the Externship Commencement Form completely, and sign and date. If the mentor is not the doctor, the doctor must also agree, and sign and date. At that time you will be given a copy of the evaluation forms for implementation.

Enclosed you will find the necessary paperwork to be signed and returned. The Voluntary Adjunct Faculty Application and once matched The Externship Commencement Form must be returned immediately to allow you and the student to begin the experience. An evaluation of the student’s performance will be given to you at the end of their experience with you. Please keep in mind that they will not be able to graduate unless these forms are returned.

Thank you again for your role in ensuring that the students have a quality experience and enter the workforce prepared and excited about their new career.

Sincerely,

Jason D. Lewis, DDS

School Director

Voluntary Adjunct Faculty Application

Office Name

Dentist Name

Office Phone Number

Fax Number

Address

City

Zip Code

Students will need to complete 60-80 hours in a dental office for to be eligible to graduate. Externships are held during the following dates.

Winter 2022 - March 28th - April 20th

Summer 2022 - July 25th - August 17th

Fall 2022 - October 17th - November 9th

Interested in hosting a student for the following session.

Dentist Mentor:

I

(name) am committed to facilitating learning and the role of mentor, and I undertake to complete all requirements associated with the mentor program.

Dentist Signature

Date

In most offices, an experienced team member is significantly involved in the training process. Please select the team member in your office that will be working with the student. If only the doctor will be working with the student, this space may be left blank.

Experienced Dental Assitant/Hygienist Mentor

I

(mentors name) am committed to facilitating learning and the role of mentor, and I undertake to complete all requirements associated with the mentor program.

Signature of DA/HYG

Date

Career Services Signature - BDAS

Date