CODHA Nomination Form 2022

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Please complete the following form for nominations for CODHA officers, elected positions, and appointed positions. Self nominations are gladly accepted.

Please see www.codha.org/nominations for the election packet which includes descriptions of each position.

Name of person submitting this form: *

Date *

YYYY

Name of person being nominated: *

Contact Email Address *

Area of Practice *

Private Practice

Public Health

Education

Other:

Dental hygiene program where nominee graduated from: *

Year of dental hygiene graduation: *

Additional education/credentials:

Recommended for which position: *

President-Elect

Chair of Council on Membership

Chair of Council on Education Services

Chair of Council on Public Affairs

Chair of Council on Regulation and Practice

Speaker of the House of Delegates

Secretary of the House of Delegates

ADHA Delegate

ADHA Alternate Delegate

Component Trustee

If running for a local component Trustee/Alternate Trustee position, please list the local component that the nominee belongs to.

If not elected, please select which appointed position(s) the nominee would be willing to serve in.

Historian

Parliamentarian

Webmaster

Facebook Administrator

Student Liaison

Explorer Editor

Financial Oversight Committee

Council Member - Regulation and Practice

Council Member - Public Affairs

Council Member - Education Services

Council Member - Membership

Council Member - Annual Session

None

Please list national, state, or local involvement of nominee. *

Please include a short bio of the nominee. *

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