University of Iowa College of Dentistry
Graduation Year:
Name:
Spouse/Significant
Other’s Name:
Address:
Home Phone:
Office Phone:
Email:
Children’s Names
& Ages:
Specialty:
What have been some of your most rewarding career highlights:
What awards/honors have you received during your dental career:
Tell us about your memories during dental school
Favorite memory of your time at the UI College of Dentistry:
What one piece of advice would you give to today’s dental students:
What people or places do you remember the most about your days in Iowa City:
Tell us about your service to your alma mater:
What are your current activities and interests (hobbies, travels, etc.):
How are you involved with your community:
Something my classmates probably do not know about me is:
How has the UI College of Dentistry contributed to your life/work:
Other information:
Please submit information by August 1
For more information please contact:
Penni Ryan
Director of Alumni Relations
University of Iowa
College of Dentistry, 346 DSB N
Iowa City, IA 52242
penni-ryan@uiowa.edu