SGA Dental Assistant Student Survey

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Name *

Phone Number *

Email *

Age

State *

Name of Assisting Program *

Are you left of right handed? *

Left Handed

Right Handed

Are you willing to travel? *

Yes

Are you looking for a Full-time or Part-time role? *

Full-time

Part-time

Do you have a preference in what kind of practice that you would like to work for? Check all that apply:

Pediatric

General Practice

Periodontics

Orthodontics

Oral Surgery

What do you expect to make hourly?

What is an area of concentration you feel most confident in? *

What is an area of concentration you feel least confident in? *

Is there a city or state that you would prefer to practice in?

What do you see as the most attractive reason for joining our team?

Employee Benefits

Less Stress

Continuing Education Courses

Other:

What SGA team member(s) have you spoken to?

At what event did you learn about SGA?

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