Awards

Dental Hygienist Life Member Award Nomination Form

The NMDHA’s Dental Hygienist Life Member Award may be granted to any professional member who has made exceptional contributions to dental hygiene and The Association over a minimum 20 year period of time, who has served The Association in a continual manner of volunteerism and gone beyond all expectations. This hygienist must be stellar!

NOTE

This application will be evaluated by the NMDHA Awards Council. Each application is blinded and scored by a panel of three (3) judges. The application will be evaluated based on the responses in each of the following sections:

• Section I Leadership Experience
• Section II Community Service Activities
• Section III Association Activities
• Section IV Membership Presentations
• Section V Essay

Each section will be evaluated independently to achieve a total composite value for each nominee evaluation. The total composite score from all council members will determine the recipients of the award.

Please allow ample time for completing the application and provide detailed information for each section.

Nominee should be able to be present for awards ceremony at NMDHA Annual Scientific Session, held in the fall. Look at nmdha.org for the exact date closer to the NMDHA Scientific Session.

Nominee Information
ADHA Member ID#
Year of Dental Hygiene Graduation *
Name *
Address 1
Address 2
City
State
Zip Code
Best Phone Number
Email
Section I Leadership Experience Do not refer to your nominee by name. All applications are scored blindly by the awards council. The Nominee or Nominator can complete this application.
NMDHA Component Experience:
Component Officer Positions held: Year(s):
Component Council Positions held: Year(s):
NMDHA Constituent Officer/Council/Committee Experience:
NMDHA Officer Positions held: Year(s):
NMDHA Council Positions held: Year(s):
ADHA National Officer/Council Experience: (Include ADHA Delegate/District Trustee Experience)
ADHA Officer Positions held: Year(s):
ADHA Council Positions held: Year(s):
Section II Community Service
Do not refer to the nominee by name. All applications are scored blindly by the awards committee. The Nominee of Nominator can complete this application. Discuss community service activities related to dental hygiene in which your nominee has been an active participant. Include the level of involvement and outcome, if applicable.
Section III Association Activities
Do not refer to the nominee by name. All applications are scored blindly by the awards committee. The Nominee of Nominator can complete this application. Describe how your nominee has contributed to the advancement of the association other than offices held, council positions, or council work. Include detailed descriptions on specific activities including level of involvement, time commitment, and outcomes.
Section IV Membership Presentations
Do not refer to the nominee by name. All applications are scored blindly by the awards committee. The Nominee of Nominator can complete this application. List and provide a description of any membership presentations made by your nominee. (CE, leadership development, legislative updates, etc.)
Section V Essay
Write an essay (300 words) detailing the contributions and how this nominee has demonstrated excellence to the profession of dental hygiene in New Mexico.