Post Graduate Year One (PGY-1) Questionnaire

Student Financial Services (SFS) at the Boston University Henry M. Goldman School of Dental Medicine is re-applying for federal funding from the Department of Health and Human Services. Part of the application process requires that we report on the activities of our graduates during PGY-1. For this reason, we ask that you complete the short questionnaire below.

We understand that you are very busy. However, the few minutes it will take to complete and return the questionnaire to our office, and the information you provide, will mean a great deal in our efforts to obtain additional funding for our dental students.

You may submit the information to SFS by completing the sections below and clicking on the “Send Form” button at the bottom of your screen.

If you have any questions about our request or the questionnaire, please contact our office at (617) 638-5130. Thank you very much for your time and consideration.

Home Address
Home Telephone #
Beeper #
Work Address
Work Telephone #
Please list work address if different than address above (otherwise please list “Same as Above’) for the next section.
Where Were You Practicing Between July 1, 2014 and June 30, 2015?
Did You Practice In Primary Care?
Were You Practicing In An Underserved Area?
By submitting this form, I certify that the information supplied is accurate.

If you have any comments or suggestions, please send an email to Student Financial Services.