Pre-Fellowship Application Form

Online Submission

When you have been nominated by a current ADI Fellow, please complete the biographical profile form complete with signature, business card and passport sized photo. Online is our preferred application method. 

  • Please allow popups in your browser to complete the application online.
  • We recommend that you clear your browser cache before proceeding with the application.

Click here to submit online

Paper Submission

If you prefer, you may complete the PDF and send to ADI. Open the fillable PDF and complete all fields, SAVE to your computer. Then print or email as a single attachment.


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: + 01(419) 542-0101