Illinois Dental Hygienists' Association Committee Interest Form

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Thank you for your interest in Illinois Dental Hygienists' Association (IDHA) Committees! Please respond to all questions and submit your application upon completion. If you have any questions, please contact the IDHA's account manager, Dana Pikowitz idha@corpevent.com or call 800-550-4342. (If you do not have a google account click 'learn more' and then 'continue without signing in'.)

Candidate Information *

First and last name

Email *

Phone number *

Mailing Address *

Please check which committee(s) you are interested in serving on?

Finance Committee: West Suburban/Fox Valley

Finance Committee: Peoria/Illini/Springfield

Finance Committee: Lake/McHenry

Please check which committee Chair(s) you are interested in serving on?

Membership

Policy and Bylaws

Public Relations

Scholarship: (to be mentored by current chair)

Please check which Executive Committee Chair(s) you are interested in serving on?

President Elect

General Assembly Chair

Treasurer

Please check which Trustee Position(s) you are interested in serving on?

Lake/McHenry- 2-year position

North Suburban/Winnebago- 2-year position

West Suburban/Fox Valley- 2-year position

Peoria/Illini/Springfield- 2-year position

South Suburban/Chicago - 2-year position

South Suburban/Chicago - 1-year position

Southern IL/Riverbend: 2-year position

Southern IL/Riverbend: 1-year position

Please check which ADHA Delegation you are interested in serving on?

Delegate with 3-year term (2 open positions)

Alternate Delegate with 1-year term (4 open postions)

What interests you the most in joining the IDHA leadership team? *

Briefly describe your volunteer experience and the extent to which this experience will serve you as a committee member. If you do not have any volunteer experience, please let us know the qualities you have that you believe will be helpful in a leadership position. *

What do you hope to accomplish in your new leadership role? *

Please give an estimated amount of time you would be able to dedicate to your new position per week. *

Thank You for your interest in joining our leadership team!

We appreciate you taking the time to submit your information for consideration.
We will review your application and respond to you as soon as possible.
If you have questions, please contact Dana Pikowitz at idha@corpevent.com or call 800-550-4342

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