Bio Data Form for District Trustee Candidates
Candidates interested in applying for a position as an ADHA District Trustee must submit a complete bio-data form and upload the required supplemental materials. Please submit your completed form and supplemental materials by February 5, 2018. If you have any questions regarding the form, please contact Tyler Dempsay at
The following supplemental information is needed to upload into your bio-data form. It is a good idea to make sure have all the supplemental information available for upload before you begin your bio-data form. 

1. Copy of current dental hygiene license.

2. Using Addendum A: District Trustee Responsibilities, Addendum B: Universal Skill Sets for ADHA Leadership Roles and Addendum C: Recommended Skill Sets for ADHA Trustees. Please describe in no more than 2 single pages (500 words or less) the skills sets that you possess and your understanding of the position and legal responsibilities of District Trustee.

3. One letter of recommendation from a fellow constituent board member that is to be uploaded directly into this submission form. The letter of recommendation CANNOT be from a current member of the Nominating Committee. Details on this letter can be found in Addendum D

4. In no more than three pages, please upload a brief resume which includes the following information in this order:

a. Education

b. Association Experience (Component, Constituent & National)

c. Professional Experience (Private Practice, Education, Managed Care)

d. Related Experience (Liaison Activities, Legislative Activities, Fundraising)

e. Unleashing Your Potential (UYP) and the year attended

f. Honors/Recognition.

5. Please complete Addendums E & F (Conflict of Interest Policy & Rules of Conduct).

If you have questions about the submission form, please contact Tyler Dempsay at