VDHA 2024 Biodata Form

Thank you for considering taking on a position. We welcome and mentor volunteers. If you are not interested in an elected position, please let us know as there are appointed volunteer leadership roles, as well.

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* 1. Name

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* 2. Membership #

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* 3. Home Address

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* 4. Phone Number

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* 5. Email Address

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* 6. Component

01 Northern Virginia

02 Greater Richmond

03 Tidewater

05 Piedmont

06 Monticello

07 Peninsula

09 Southwest Virginia

10 Northwest

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* 7. Licensure Status

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* 8. Current professional position

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* 9. POSITION YOU SEEK FOR ELECTED OFFICE

President Elect

Vice President

Recording Secretary

Treasurer (elected in the odd years, 2-year term)

Speaker of the House (elected in the odd years, 2-year term)

Alternate Speaker of the House

ADHA Delegates (elect up to 5 delegates/alternate delegates)

VDHA Foundation Secretary (elected in even years, 2-year term)

VDHA Foundation Treasurer (elected in the odd years, 2-year term)

Please attach, in an email, the following items with this Biodata Form

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* 10. Copy of current dental hygiene license.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 11. In no more than a one-page Word document, create a brief resume which includes the following information in this order:
Education
Professional Experience (Private Practice, Education, Managed Care)
Association Experience (Component, Constituent & National)
Related Experience (Liaison Activities, Legislative Activities, Fundraising)
Honors/Recognition

PDF, DOC, DOCX file types only.

Choose File

Referencing the Universal Skill Sets for VDHA Leadership Roles, please answer each of the following 3 questions in no more than 2-3 sentences:

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* 12. What motivates you to become a board member?

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* 13. Why would you be a good fit to serve in this position?

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* 14. What do you feel is essential to ensure that the board and staff are successful in attaining the goals for this organization?

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* 15. What skills and knowledge are you willing to bring to our board? Please indicate your experience in the following areas. Rate 1-3, with 3 being very experienced, 2 some experience, and 1 being little to no experience.

	1	2	3
Fundraising	Fundraising 1	Fundraising 2	Fundraising 3
Board Development (recruitment, training, evaluation)	Board Development (recruitment, training, evaluation) 1	Board Development (recruitment, training, evaluation) 2	Board Development (recruitment, training, evaluation) 3
Program Planning and Evaluation (trainings, outreach)	Program Planning and Evaluation (trainings, outreach) 1	Program Planning and Evaluation (trainings, outreach) 2	Program Planning and Evaluation (trainings, outreach) 3
Financial management and control (budgeting, accounting)	Financial management and control (budgeting, accounting) 1	Financial management and control (budgeting, accounting) 2	Financial management and control (budgeting, accounting) 3
Public Policy, legislative advocacy	Public Policy, legislative advocacy 1	Public Policy, legislative advocacy 2	Public Policy, legislative advocacy 3
Communication, Public and Media Relations	Communication, Public and Media Relations 1	Communication, Public and Media Relations 2	Communication, Public and Media Relations 3
Public Speaking	Public Speaking 1	Public Speaking 2	Public Speaking 3
Strategic Planning	Strategic Planning 1	Strategic Planning 2	Strategic Planning 3
Information Technology (website, listserv, etc)	Information Technology (website, listserv, etc) 1	Information Technology (website, listserv, etc) 2	Information Technology (website, listserv, etc) 3
Special Events (planning and implementing)	Special Events (planning and implementing) 1	Special Events (planning and implementing) 2	Special Events (planning and implementing) 3

If you listed 3's in any categories, please provide an example of how you gained this experience.

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* 16. I understand that any VDHA position indicates a substantial personal commitment as well as willingness to represent VDHA’s missions, goals, and policies. I assume responsibility for updating VDHA of any changes in the information submitted. I understand that I will be required to sign the VDHA Rules of Conduct Form. Only VDHA Members are eligible.

I understand

Other (please specify)