Michigan Dental Assistants Association

P. O. Box 118

Lennon, MI 48449

MDAA ACHIEVEMENT AWARD APPLICATION

This award is given al the Local that has sponsored the most seminars, community projects, membership drives and other activities related to dental assisting and the promotion of the Association.  This is based on a point system.  The Local that receives the most points shall be declared the winner.  In case of a tie the Board of Directors shall have final approval.

Society _______________________________________________

Prepared by ____________________________________________

Do not write here                                                   

Total Points _____

 _____ (5)   1)  Has your society sponsored an A.D.A.A. Continuing                                                Education Course?

          Title:_____________________________________________

_____(5)     2) Has your society sponsored an all day seminar, workshop                                       or equivalent?

        (Example: Two or more evenings equal to eight hours?)

Title: ___________________________________________

_____ (1 each) 3)  Community projects sponsored by your society, i.e.,

1. Children’s Dental Health Week

b)  Toothbrush instructions in schools (not if same as a)                          

c)  Career Day Program in local schools

1. Other ____________________________________________

                ____________________________________________

_____(1 each)   4)   How many of your meetings have educational programs?                                                                                                    List date and topic.

  _________________________________________________________

  _________________________________________________________
              _________________________________________________________
              _________________________________________________________

_____ (1) each 5)  How many table clinics were presented at your society meetings? List each one with name of clinician:        

_____________________________________________________________

_____________________________________________________________

_____6)  How many NEW members joined your local society as a result                (1) each    of a membership drive? ___ List their names:

           ______________________                 _____________________

           ______________________                 _____________________

           ______________________                 _____________________

           ______________________                 _____________________

           ______________________                 _____________________

_____7)  Are there any other activities that your society feels it should   

(1) each     receive credit for?  Please describe. 

           _____________________________________________________

           _____________________________________________________

           _____________________________________________________

           _____________________________________________________

If more space is needed to answer any question please use the space below and

reference the questions number.     

 Please return completed form by:  March 1, 2012

Either Snail Mail  or email to:

Barbara Gurnee CDA, R.D.A., FADAA, BS

MDAA Awards Chairperson

4438 Two Mile Road

Bay City, MI  48706

Phone:  989-684-9896

Email:  bgurnee9896@charter.net

Membership Awards

Two awards are presented in this category. One is for the Local with the greatest percentage of increase in membership and the other is for the greatest numerical increase according to dates determined by the Board of Directors. Certificates may be presented to the runners up in both categories.

MARALEE ALBRECHT IMPACT AWARD APPLICATION

This award was named in honor of MaraLee Albrecht, MDAA Honorary Member and a very active member of the Michigan Dental Assistants Association. It is given to the member who has either contributed toward legislative pursuits and/or made educational presentations in the dental field.  This person may be nominated by a Local or an individual member. The committee shall review all applications and present the best applicant to the Board of Directors for approval.  The current MDAA President is not eligible for this award.

Date:      _____________________

I wish to place in nomination________________________________________ for the MaraLee Albrecht Impact Award.

Please fill out your contact information for the committees use:

Name:_______________________________Phone:_____________

Address:_____________________________________

City_______________Zip_________

Fax:____________________________________

Email:_________________________________

Please submit a typewritten nomination letter stating which local society the nominee belongs to, their previous offices held on the local, state or national level and in what ways they contributed to the profession using the guidelines below. 

Choose one topic:

1. How has this person contributed to legislative pursuits? In what way have they been instrumental in initiating legislative change?
2. How has this person made educational contributions?  (i,e.,lectures, seminars, table clinics, books, papers, visual aids, etc.)

The deadline to receive nomination forms is:     March 1, 2012

Please snail mail or e-mail this form and your typed nomination letter to:

MDAA Awards Chairman

Barbara Gurnee CDA, R.D.A., FADAA, BS

4438 Two Mile Road

Bay City, MI  48706

989-684-9896

bgurnee9896@charter.net

RUTH M. EDWARDS SERVICE AWARD APPLICATION

This Award was named in honor of Ruth M. Edwards, Life Member and a very active member of the Michigan Dental Assistants Association.  This award is given to the member who has demonstrated exceptional leadership, interest and motivation in the profession of dental assisting and/or in community service.  A local or an individual member may nominate this person.  The committee shall review all applications and present the best application to the Board of Directors for approval.  The current MDAA President is not eligible for this award.                       

 Date_____________________

I wish to place in nomination __________________________________________ for the Ruth M. Edwards Service Award.

Please fill out your contact information for the committees use:

Name:____________________________________

Phone  __________________________

Address:_____________________City__________________

Zip code__________________

FAX_______________________ Email __________________

Address___________________________________

Please submit a typewritten nomination letter stating which local society the nominee belongs to, their previous offices held on the local, state or national level and in what ways they contributed to the profession using the guidelines below:

How has this person demonstrated exceptional interest, motivation, and leadership by promoting and upholding the profession of dental assisting, with active participation in our Association; i.e., Component, Constituent, and/or National level? This member may also have demonstrated commendable and unselfish service for their community.

 The deadline to receive nomination forms is: March 1, 2012

 Please mail or email this form and your typed nomination letter to:         

MDAA Awards Chairman

Barbara Gurnee CDA, R.D.A., FADAA, BS

4438 Two Mile Road

Bay City, MI  48706

Bgurnee9896@charter.net