Other, please specify:

4 years/48 months OMS Certificate MD Integrated 6 years/72 months

MD Alternative 5-7 years/60-84 months
OMS/MS 4 years/48 months
PhD 7-8 years/84-96 months
Yes
Prior to OMS residency the resident completed: (please check all that apply)
Last, Suffix
Date and Place of Birth:
Month, Day, Year, City State Country
Name of Collegeor University
States Licensed to Practice Medicine/Dentistry/OMS
Type of License,
Type of License
Degrees Middle, First
RESIDENT PROGRAM TYPE AND DURATION (please select one) OMS Program :
Start Date Graduation Date Degree
Name of College or University Start Date Graduation Date Degree
Start Date Graduation Date Degree Name of College or University
LicenseNumber
LicenseNumber
State
State
Renewal and Expiration Date
Renewal and Expiration Date
Male
African/American
Female
Hispanic
American Indian
Middle Eastern
Asian
Other please list:
Caucasian
US Citizen
N/A AED GPR Internship Externship Other:
Has Resident obtained MD No
If resident is interested in being the program
contact for the AAOMS Resident Organization
ExecutiveCommittee Please check Here
l
Full Name:
Email Address: AAOMS Member ID:
Dental School:
Medical School:
Other Post Graduate Training:
HomeAddress 1:
HomeAddress 2:
City: State: Zip:
Phone: Pager : Cell Phone:
Training Start Date: Training End Date:
//20
RETURN TO:
American Association of Oral and Maxillofacial Surgeons
Attn: Mary E. Allaire-Schnitzer, Advanced Education and Resident Affairs
9700 W. Bryn Mawr Avenue, Rosemont, IL 60018
FAX: 847/678-6286 or E-Mail: mallaire@aaoms.org
American Association of Oral and Maxillofacial Surgeons
Resident Membership Application
For US/Canadian residents and Interns only
Donald Jean Goudreau, III DMD
dgoudreau@gmail.com
December 14, 1987 Pensacola FL USA
University of Connecticut Aug 2009 May 2013 DMD
Drexel University College of Medicine Sept 2014 May 2016 MD
Medical Training License PA
Apt 2E
Philadelphia PA 19107
262-366-6936
Drexel Univ.
1010 Race St
July 2014 June 2020