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Form 5R- Residency Director's Roster

Only for use by directors of residency programs approved by the Commission on Dental Accreditation (CODA) of the American Dental Association. This form is to be submitted no later than 60 days after the start of a resident's program. An individual check for each eligible resident, made payable to the New York State Education Department in the amount of $105 should be attached to this form with the check number recorded in the appropriate column. This fee is payable annually for each academic year for the duration of the program as approved by CODA. Note: A Dental Education Record Form needs to be submitted for each resident whose dental degree is from a non-accredited institution (ie. dentists from schools outside the US or Canada.).