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Consultant Application

Deadline for submission, September 1

First Name *

Last Name *

Email *

Email Confirm *

Address *

City *

State *

Zipcode *

Phone *

Fax *
Clinical Practice *
Clinical Setting *
Date of attendance at the AAPD Comprehensive Review of Pediatric Dentistry *
Dates of attendance at AAPD Annual Session *



Reference Name 1 *

Reference Email 1 *

Reference Name 2 *

Reference Email 2 *
  • Applicant must be a member of AAPD.
  • Agreement of Confidentiality: I am aware that in my service as a Consultant of the American Board of Pediatric Dentistry, I have access to and knowledge of confidential information, including board certification and examination information. I hereby agree to keep confidential all information I am privy to because of my service to the Board. Such information could include, but not be limited to, certification materials, examination results, discussion from Board meetings, education workshops, and examination critiques.
    Furthermore, I hereby agree that any disclosure of confidentiality can be injurious to the reputation of the Board, and could result in litigation. Therefore, I agree to hold harmless the Board for any intentional breech of confidentiality on my part.
  • Statement of Personal Commitment: If appointed to serve as a Consultant, I will be available to participate in the Oral Clinical Examination if invited on an annual basis, and my expenses will be covered per ABPD travel guidelines.

    As a Consultant I will be available to actively participate via email prior to the examination.



Submit Application

The ABPD is the only ADA recognized certifying Board for the specialty of Pediatric Dentistry.
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