2008 ESTHER WILKINS AWARD APPLICATION

DEADLINE: MARCH 4, 2008

INSTRUCTIONS FOR THE APPLICATION: Nominations are open to any Member Registered Dental Hygienist.  Send each application in typewritten form.  Please complete each of the following sections.  You must complete an application in order to be chosen for the award.

NAME:______________________________________ SSN:_____________

ADDRESS:____________________________________________________

Education, (post high school), include name of school(s), date graduated or dates attended, major and certificate or degree completed.

Years of practice in Dental Hygiene.

Continuing Education Courses:  List all taken in the last three years, including course name, presenter and where taken.

Awards received (These include dental hygiene or others).

Participation in Dental Hygiene Activities (e.g. councils, committees, officer or delegate).

Participation in Community or Social Service Organizations (e.g. dental school, judging table clinics/GHDM, American Heart Association, American Cancer Society, etc.)

Political Involvement and Legislative Activity (e.g. Lobby Day, local campaigns).

Letters of recommendation from a Colleague or Employer.  Please limit to three.

Please send completed applications to:

Stephanie Bass, RDH, BSDH, CPTI

1914 Edenfield Lane

Sugar Land, TX 77479

(281) 980-8524

ATTENDANCE AT THE GREATER HOUSTON DENTAL HYGIENE MONTHLY MEETING ON TUESDAY APRIL 8, 2008 IS REQUIRED!