Hispanic Dental Association
2012 Women’s Leadership Award
The Hispanic Dental Association Women’s Leadership Award recognizes and honors women who have helped to advance the
HDA mission, displayed exceptional character, and distinguished themselves as outstanding role models in the field of dentistry
through our SEAL (Service, Education, Advocacy and Leadership). TWO awards are available – one for Leadership and
Advocacy and one for Service and Education, and recipients are selected by a review panel comprised of members of the HDA
Awards Committee.
Award Recipients will receive the following:
 Recognition and award plaque/trophy at the 2012 HDA Annual Meeting – Women Dentists’ Award
Brunch on Saturday, July 21, 2012 at the Boca Raton Resort & Club, 501 East Camino Real, Boca
Raton, Florida.
 A complimentary HDA professional membership for the 2013 member year.
CRITERIA FOR SELECTION:


Must be a current HDA member.
Must demonstrate exemplary values, dedication, and be an outstanding role model in the field of
dentistry.
GUIDELINES FOR SUBMISSION:
1. Submit a Letter of Nomination (a narrative describing the nominee’s accomplishments – not to exceed two pages,
single spaced). Nomination MUST address which SEAL component specifically characterizes the nominee. Indicate
in the Letter a detailed description of how the nominee meets the award criteria. Give examples of specific activities
that have been accomplished and/or participated in by nominee.
2. Complete the Nomination Form on page two to include contact information of the nominee and the person nominating.
(Self nomination is allowed and welcome.)
3. Attach nominee’s curriculum vitae (CV) as well as a biography not to exceed one page, single spaced.
4. Email (no snail mail please) Letter of Nomination, completed Nomination Form, CV and biography to
HispanicDental@hdassoc.org . DEADLINE: Friday, June 15, 2012.
5. Late submissions will NOT be accepted.
Questions? Contact HDA Executive Director, Dr. C. Yolanda Bonta at ybonta@aol.com .
PLEASE NOTE: No reimbursement for the award winner’s travel expenses and/or lost income will be given.
Page Two
Hispanic Dental Association
2012 Women’s Leadership Award
Nomination Form
SUBMISSION DEADLINE: 6/15/12
Nominee Full Name
Credentials
Title
Organization
Address
Address
City / State / Zip
Email Address
Work Phone
Cell or Home Phone
Person Nominating
Full Name
Credentials
Title
Organization
Address
Address
City / State / Zip
Email Address
Work Phone
Cell or Home Phone