Outstanding Service to Dental Hygiene Award Nomination

Completed nomination form should be sent to the Vice President at [email protected]

DUE DATE: August 15, 2025

Award Criteria:

Candidate’s professional activities include participation in WI-DHA activities for a minimum of three continuous years. (Activities might include committee participation, originating or promoting programs, representing the dental hygiene profession, serving on the WI-DHA board of directors, etc.)
Demonstrate qualities of an excellent role-model of Dental Hygiene professionalism and leadership.

Person nominating:
Contact info:

Name(Required)

Email(Required)

Phone(Required)

Nominee:
Contact info:

Nominee Name(Required)

Nominee Email(Required)

Nominee Phone(Required)

1. List dental hygiene activities this person has been involved in. Include participating in WI-DHA activities for a continuous three-year period, including student involvement.

2. List qualities that demonstrate this person is a good model of dental hygiene professionalism and leadership.

3. Include any activities this person has been involved in at the WI-DHA level.

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