Embed Size (px)
Citation preview
Community Oral Health Champion nomination form
Oral Health Project of the YearNomination form
Nominee details Your details (if applicable)
Name Click here to enter text. Name Click here to enter text.
Organisation Click here to enter text. Address Click here to enter text.
Phone Click here to enter text. Phone Click here to enter text.
Email Click here to enter text. Email Click here to enter text.
In 500 words or less, please outline how your nominated project has shown excellence in public dentistry.
The judging panel will take into account the following considerations in reaching their decision:
How the project has shown excellence in improving service delivery How the project has shown excellence in taking a population health approach
encouraging external partnerships to promote community health
Terms and conditions of the awards can be found on www.dhsv.org.au/awards.
Click here to enter text.
Please remember to attach any supporting documentation to your nomination upon submission.
Community Oral Health Champion nomination form
Nominee details Your details (if applicable)
Name Click here to enter text. Name Click here to enter text.
Organisation Click here to enter text. Address Click here to enter text.
Phone Click here to enter text. Phone Click here to enter text.
Email Click here to enter text. Email Click here to enter text.
In 500 words or less, please outline how your nominated project has shown excellence in public dentistry.
The judging panel will take into account the following considerations in reaching their decision:
How the project has shown excellence in improving service delivery How the project has shown excellence in taking a population health approach
encouraging external partnerships to promote community health
Terms and conditions of the awards can be found on www.dhsv.org.au/awards.
Click here to enter text.
Send your completed nomination to [email protected] or submit an online nomination. Nominations close on September 25.
Winners will be announced at the 2015 DHSV AGM on November 26.
