Fellowship Application Form

Online Application

If you have been nominated or are interested in Fellowship and wish to apply, please complete the biographical profile form complete with signature, business card and passport sized photo. Online is our preferred application method. 

Click here to apply online

Paper Application

If you prefer, you may apply via PDF and send to ADI.


Academy of Dentistry International
3813 Gordon Creek Drive
Hicksville OH 43526 USA

or via Email:



Academy of Dentistry International®
3813 Gordon Creek Drive
Hicksville, Ohio 43526 U. S. A.
Tel: + 001(419) 542-0101
Fax: +001(419) 542-6883