WDHA Faculty Membership Award Application

Award for the 2018-2019 Academic Year

 

The Washington Dental Hygienists' Association may annually recognize accredited Washington State dental hygiene programs that have 100% membership in ADHA/WDHA by all dental hygiene faculty (part-time and full-time), by presentation of an engraved plaque or year marker at our House of Delegates and acknowledgement in Association publications.

First Name
Last Name
Mailing Address
City
State
Zip
Contact Phone #
Email
Submission for which Dental Hygiene Program?
ADHA ID Number
If your school is a past recipient of this award, does the plaque still have space for another year plate?
 Yes
 No
How many total faculty members are in your school's dental hygiene program?
Please list the full name for each faculty member and year(s) of service. (ie Jane Doe, 2018. John Smith, 2018-2019. Pat More, 2019)
Will a representative from your school be present at WDHA HOD to receive the award? If so, please list their name.
Please type this statement below. I attest that all of our faculty members are members of ADHA/WDHA.

Deadline for Application: September 15th

Only online applications will be accepted.

 

Before submitting this form, please click on the link below to move the contents of box "A" into box "B" leaving the first box empty.

A: B: Click to Move