Reporting Form

An Affiliate of Delta Dental of Michigan, Ohio, and Indiana
Dental Master’s Thesis Award Program
Reporting Form
When the Delta Dental Foundation awards a grant, we enter into a partnership with you that we hope will help us to learn more
about effective ways to improve oral health. This report is the primary tool we use in measuring the achievements of the projects
we support and the impact that our philanthropic dollars have in the communities we serve.
Thank you in advance for taking the time to provide us with a thorough and thoughtful report.
Name: School, department and program: Project title: Email: Phone:
Amount of funding received: $
Graduation date: Name of thesis advisor: Provide a brief assessment of your overall state of knowledge in your chosen field of research. How has this project contributed
to that knowledge base?
List any other presentations or publications that you’ve made beyond the thesis defense:
Please attach a copy of the abstract from your completed thesis. Students are no longer required to submit a copy of the
bound thesis.
Please complete and return this form to [email protected] or fax to (517) 347-5320 upon completion of your
Master’s Thesis.
Contact us at:
Delta Dental Foundation
PO Box 293
Okemos, MI 48805-0293
Phone: (517) 347-5333
[email protected]
DDF-DMT Reporting Form
PA 5/13