Dentistry
Medicine
Public Health
AlliedHealth
Nursing
Graduate Studies
LSUHSC School of Dentistry
Community Outreach Form
Project/Event Name
Project Coordinator
Phone Number
Email Address
Department/Program:
Dental Hygiene
Dental
Residency
Residency (Depts.)
Outreach Category:
School
Health Fair
Conference/Event
Other
Other (Please describe)
Care Provided:
Educational Activities
Screenings
Dental Care
Other
Other (Please describe)
Was the LSUD Tooth Bus Used?
Event Date
Location
Time
Other Organizations/Partners
Brief Description of Project and Services Provided
Number of Student/Resident (LSUSD) Participants
Number of Faculty Participants
Number of Patients Served
Were photos taken?
