KEY & RELEVANT ACADEMIC ACHIEVEMENTS

• Please describe in detail your most relevant research project that equips you for the advertised ACF post: (Text box (long answer) · Limit: 200 words)
• Please give brief details of your other research projects and/or relevant research experience, including the methods used. Indicate your level of involvement and your exact role in the research team: (Text box (long answer) · Limit: 200 words)

SCIENTIFIC PRESENTATIONS AND SCIENTIFIC PUBLICATIONS

Please list published abstracts, original research articles and reviews. Please provide details of relevant scientific presentations and whether these were at a departmental, national or international level. Please give a statement about your personal contribution to the work (e.g. first author, lead investigator)

• Presentations at regional or national level: (Text box (long answer) · Limit: 200 words)
• Presentations at local level: (Text box (long answer) · Limit: 200 words)
• Publications in peer review journals: (Text box (long answer) · Limit: 200 words)
• Other publications - conference extracts etc: (Text box (long answer) · Limit: 200 words)

OTHER RELEVANT EXPERIENCE

Please list any formal teaching role(s) you have had to-date, where this is relevant to research and whether you have any teaching qualifications e.g. FHEA. You may also include examples outside of dentistry.

• TEACHING EXPERIENCE What formal teaching role(s) have you undertaken?: (Text box (long answer) · Limit: 200 words)
• Do you possess any teaching qualification(s)? (Text box (long answer) · Limit: 200 words)

AIMS, CAREER OBJECTIVES AND COMMITMENT TO A CAREER IN DENTISTRY

• SUITABILITY FOR SPECIALTY Please indicate your medium and long-term career goals in relation to an academic career. Please explain why you want to undertake an NIHR ACF. Please also explain how the hosting research department will support your research aims and career objectives: (Text box (long answer) · Limit: 200 words)

DENTAL AND CLINICAL EXPERIENCE

QUALIFICATIONS - DEGREE/DIPLOMA

ADDITIONAL ACHIEVEMENTS - PRIZES, AWARDS AND DISTINCTIONS

Additional Undergraduate Degrees and Qualifications

• Qualification (Text)
• Grade (Text)
• Date completed (Date)
• Place of study (Text)

Postgraduate degrees and Qualifications

• Subject/Qualification (Text)
• Place of Study (Text)
• Grade/Result (Text)
• Date qualification awarded (Date)

Additional Achievements - Prizes, Awards and Distinctions

• Prize/Award/Distinction (Text · Limit: 50 words)
• Awarding Body (Text · Limit: 50 words)
• Undergraduate or Postgraduate (Drop-down)
  • Undergraduate
  • Postgraduate
• Date awarded (Date)

Training Course Attended

• Course Title (Text · Limit: 50 words)
• Training Provider (Text · Limit: 50 words)
• Duration of Course (Text · Limit: 50 words)
• Date Completed (Date)

Grades and CCT Dates

• What date are you expected to progress to the next grade of training (assuming satisfactory ACRP outcome) For trainees training LTFT or are otherwise out of sync, please ensure you state the date you will go up to the next training grade, not the usual rotation date for your specialty. * (Date)
• What grade will you be on the date you have stated above? * (Text)
• What date will you complete your training programme (e.g. CCT date or date of completion of core training) * (Date)

Achievements outside Medicine

• Please give details of outstanding achievements outside the field of medicine (Text box (long answer) · Limit: 100 words)

Presentations and Publications

• Presentations at Local or Regional level (Text box (long answer) · Limit: 600 words)
• Presentations at National level (Text box (long answer) · Limit: 600 words)
• Presentations at International level (Text box (long answer) · Limit: 600 words)
• Publications in peer review journals as a co-author (Text box (long answer) · Limit: 600 words)
• Publications in a peer review journal as a first author (Text box (long answer) · Limit: 600 words)
• Other publications - conference extracts etc. (Text box (long answer) · Limit: 600 words)

Teaching and Audit

Teaching Experience

• What experience do you have of delivering teaching? (Text box (long answer) · Limit: 600 words)
• Have you undertaken a teaching skills course or a formal qualification in teaching? (Text)
• Please provide details of the teaching qualification attained (Text box (long answer) · Limit: 250 words · Conditional)

Clinical Audit

• What experience of clinical audit do you have? Please state clearly where and when this was undertaken and state specifically your role in each of the projects. (Text box (long answer) · Limit: 600 words)

Suitability for Specialty

• Describe how you believe you meet the person specification for the programme you are applying for. Include the particular skills and attributes that make you suitable for a career in this specialty (Text box (long answer) · Limit: 200 words)

Commitment to specialty - Achievements and Activities

• Please provide evidence of activities and achievements which demonstrate your commitment to a career in this specialty and/or have led to the development of skills relevant to career in this specialty (Text box (long answer) · Limit: 200 words)

Management, leadership, teamworking and communication skills

• Please provide evidence of activities and achievements which demonstrate your skills in the above, relevant to a career in this specialty (Text box (long answer) · Limit: 200 words)

Research skills

• Please give brief details of all research projects, and/or relevant research experience that you have undertaken or are undertaking, including methods used. Indicate your level of involvement and your exact role in the research team detailing when this took place, your time commitment, your contribution/involvement and source of funding. If you have been awarded a higher degree as a result of research, this must be detailed additionally in the appropriate section above. Detail your academic career plans, if applicable. (Text box (long answer) · Limit: 600 words)
• Please describe in more detail one of the research projects above (Text box (long answer) · Limit: 300 words)
• Please say why you want this particular Academic Clinical Fellowship, indicating your medium and long term career goals in relation to an academic career in this specialty area. (Text box (long answer) · Limit: 300 words)

Dental and Clinical Experience

• Department/School (Text)
• Qualification (Text)
• Date completed (Date)
• Place of study (Text)

Degrees and Diplomas

• Subject/Qualification (Text)
• Place of Study (Text)
• Grade/Result (Text)
• Date qualification awarded (Date)

Additional Achievements - Prizes, Awards and Distinctions

• Prize/Award/Distinction (Text · Limit: 50 words)
• Awarding Body (Text · Limit: 50 words)
• Date awarded (Date)

Key and Relevant Academic Achievement

• Please give details of relevant academic achievements (Text box (long answer) · Limit: 100 words)

Presentations and Publications

• Please Give Details of Relevant Scientific Publications (Text box (long answer))
• Please Give Details of Relevant Scientific Presentations (Text box (long answer))
• Please Give Details of Any Other Relevant Experience (Text box (long answer))

Commitment to specialty - Achievements and Activities

• Please provide evidence of activities and achievements which demonstrate your commitment to a career in Academic Dentistry and/or have led to the development of skills relevant to career in this specialty (Text box (long answer) · Limit: 200 words)
• Please Provide your aims and career objectives in Academic Dentistry (Text box (long answer))

Academic Referees

• Name (Text)
• Job Title (Text)
• Organisation (Text)
• Referee Start Date (Date)
• Referee End Date (Date)
• Name (Text)
• Job Title (Text)
• Organisation 2 (Text)
• Referee Start Date (Date)
• Referee End Date (Date)

Eligibility for the Performers List

• Are you currently registered on the Dental Performers List for England? (Yes/No buttons)
• Are you eligible to join the Dental Performers List for England and will be fully registered by the start date of the post (September 2026)? (Yes/No buttons · Conditional)

Please note that where it is confirmed that posts will utilise placements in primary care settings, we are unable to consider applicants who will not be registered on the Dental Performers List for England by the start date of the post. (Conditional)

Additional Undergraduate Degrees and Professional Qualifications

• Qualification (Text)
• Place of study (Text)
• Grade (Text)
• Start Date (Date)
• End Date (Date)

Postgraduate Degrees and Qualifications

• Subject / Qualification (Text)
• Place of study (Text)
• Garde / Result (Text)
• Date qualification awarded (Date)

Additional Achievements - Prizes, Awards and Distinctions

• Prize / Award / Distinction (Text)
• Awarding Body (Text)
• Undergraduate or Postgraduate (Drop-down)
  • Undergraduate
  • Postgraduate
• Date Awarded (Date)

Training Courses Attended

• Course title (Text)
• Training Provider (Text)
• Duration of Course (Text)
• Date Completed (Date)

Other relevant experience

• Please list any formal teaching role(s) you have had to-date, where this is relevant to research, and whether you have any teaching qualifications e.g. FHEA. You may include experience gained outside of dentistry. (Text box (long answer))

Scientific Publications and Presentations

• Publications (Text box (long answer))
• Presentations/posters at national or international conferences (indicate whether local / regional / national / international). (Text box (long answer))

Key and Relevant Academic Achievements

• Please describe in detail your most relevant research project that equips you for the advertised ACF post (up to 250 words). Please give brief details of your other research projects and/or relevant research experience, including the methods used. Indicate your level of involvement and your exact role in the research team. (Text box (long answer) · Limit: 250 words)

Aims, Career Objectives, and Commitment to a Career in Academic Dentistry

• Please indicate your medium and long-term career goals in relation to an academic career. Please say why you want a NIHR ACF. Explain how the hosting research department will support your research aims and career objectives. (Text box (long answer))