2024 Yvette Blum Mentor Award Nomination Survey

PURPOSE - To recognize a dental hygienist for their outstanding devotion as a mentor to fellow dental hygienists during their career as a dental hygienist.

CRITERIA - The nominee consistently:
A.     Lends support to student hygienists
B.     Mentors hygienists to become members in ADHA/FDHA
C.     Encourages member hygienists to become active in component activities by serving on committees, as officers or as delegates
D.     Educates hygienists of legislative issues that impact the profession
E.     Supports hygienists to become active in FDHA on the state level
F.     Maintains an open-door policy on helping fellow hygienists

1.What is your name and credentials as the person submitting the nomination for the FDHA Yvette Blum Mentor Award. (For example: Jane Doe, CRDH)(Required.)

2.What is your ADHA Membership ID? (locate the number on the ADHA website under Member login)

3.What is the name and credentials of the member you are nominating for the FDHA Yvette Blum Mentor Award? (For example: Jane Doe, CRDH)

4.As the nominator, confirm that you have emailed the nominating letter to the FDHA Yvette Blum Mentor Award Chair, Robin Poole at poole.robin@gmail.com; and added a return receipt for delivery confirmation. (Select only one)(Required.)

Yes, I have emailed the nomination letter; and added a return receipt for delivery confirmation.

No, I have not emailed the nomination letter; and added a return receipt for delivery confirmation. I understand this is my responsibility in order for the nomination to be considered; and acknowledge the June 30th submission deadline.

5.As the nominator, confirm that you have notified the nominee of this nomination; and provided the date of the Awards Ceremony where the award winner will be announced. (Select only one)(Required.)

Yes, I have notified the nominee of this nomination; and the date of Awards Ceremony.

No, I have not notified the nominee of this nomination; and the date of Awards Ceremony. I understand this is my responsibility to the nominee.

6.What is the best email address to reach you?

7.What is the best phone number to reach you?

Current Progress,

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