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Connection Opportunities Form

Thank you for your interest in Connection Opportunities. The information you share will be used to match you to an individual that best meets your oral health goals. If you have questions or difficulty completing the form, please email DHSOralHealthPathway@dhs.wisconsin.gov.

The Wisconsin Oral Health Program will make connections based on career interest, demographics, and geographic location (for job shadowing purposes) whenever possible. Our goal is to match individuals with the exact connections they are interested in, but despite our best effort, sometimes this is not possible.
 
1. Which of the following best describes you? 

High school student refers to any person enrolled in grades 9-12.
Dental profession student refers to any person enrolled in a dental program (e.g., dental assistant, dental hygiene, dental lab tech, and dental school). 
Dental professional refers to any person practicing as a dental assistant, dental hygienist, dental lab tech, or dentist. *This question is required.