WDHA Partner in Health Award Application

The Association may annually present a “Partner in Oral Health” Award at the House of Delegates to a non-dental hygienist who recognizes and promotes the valuable role licensed dental hygienists play in the health of all citizens.  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

Please submit two letters of recommendation. The letters should from individuals having direct knowledge of nominee's specific projects, accomplishments, events, programs and activities, along with a timeline of the aforementioned, that highlight the nominee’s support, recognition and promotion of the role licensed dental hygienists play in the health of all citizens. 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