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Indiana University School of Dentistry 1121 W Michigan Street Indianapolis, IN 46202 Please complete this form and return to: Indiana University School of Dentistry Office of Graduate Education 1121 W Michigan Street, Room 280B Indianapolis, IN 46202 If you wish, you may send completed form electronically to [email protected] The faculty in the Indiana University School of Dentistry, Department of Orthodontics feel that residency program participation in the Postdoctoral Dental Matching Program is fair and beneficial to applicants. We also believe that Match participation is in the long-term best interest of the orthodontic specialty. Therefore, we have decided to interview applicants who are applying exclusively to programs participating in the Match. Please answer the following question regarding your program application intentions. Are you applying exclusively to programs participating in the Match? Yes No ____________________________________ Printed Name ____________________________________ Signature ___________________________ Date This form must be completed and returned in order to be considered for an interview at Indiana University School of Dentistry. Thank you.