WDHA Norma J Wells Community and Global Partnership Building Award Application

The Association establishes an award to recognize dental hygienists for their contribution to community and global partnership and relationship building. The recipient will be chosen from qualified nominees. This award will be presented at the House of Delegates.

To qualify, the nominee must have:
•    Minimum of 5 years of ADHA membership
•    Minimum of 5 years as a licensed and registered dental hygienist
•    Contributions in initiating, contributing or participating in local, national or international partnership building and/or growing or maintaining relationships in the interest of the profession of dental hygiene.

 

Applications must be received at Central Office no later than 4 pm on the first Friday of August. The 2019 deadline is August 2nd.

 

Application Submitted By:

First Name
Last Name
Mailing Address
City
State
Zip
Contact Phone #
Email

Nominee Information

 

Nominee's First Name
Nominee's Last Name
Mailing Address
City
Zip
State
Nominee's Phone #
Nominee's Email
Minimum 5 years Professional Membership in WDHA:
Minimum 5 years as a Registered Dental Hygienist:
Contributions in initiating, contributing or participating in local, national or international partnership building and/or growing or maintaining relationships in the interest of the profession of dental hygiene.
Nominee's Curriculum Vitae

Please submit two letters of recommendation to support nomination from individuals having direct knowledge of nominee's accomplishments, including:

 

a) Describe specific projects, events, programs

b) Include names of collaborating individuals, groups or organizations/affiliations whose relationships have been formed or strengthened because of the efforts of the nominee

c) Describe how this relationship had supported the mission of WDHA.

 

Letters can be uploaded with online application, emailed to wsdha@comcast.net, or mailed to PO Box 389, Lynnwood, WA 98046. Letters must be postmarked by 8/2/19.

Upload your recommendation letter 1
Upload your recommendation letter 2
Are you attending this year's House of Delegates?
Please type your full name below for your signature.

Deadline for Application: August 2, 2019

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