2013NominationForm

Document Sample
2013NominationForm Powered By Docstoc
					                               Academy of General Dentistry Guidelines
                               2013 Achievement Awards



Awards Profile
   Provide recognition to individuals for outstanding achievement relevant to the dental profession.
   Demonstrate to AGD members and others that the organization values and recognizes these achievements.
   Motivate AGD members and others to improve and enhance dentistry through their day-to-day work.
   Encourage volunteerism in AGD and the industry through recognition.

Call for Nominations and Review Process
Deadline for Award Submission (postmarked no later than October 23) ................................................. November 1
Board of Trustees Selections ............................................................................................... Winter 2013 Board Meeting
Award Presentation ............................................................................................ 2013 AGD Annual Meeting (Nashville)


Guidelines
 Official letter of recommendation (no more than two pages) for basis of nomination.
 A fully completed nomination form including questions addressing the services, efforts and achievements of the
  nominee.
 Other supporting documentation to substantiate character of the nominee (letters of recommendation, testimonials,
  newsletters, articles, photographs and brochures).
 If accessible, provide a curriculum vitae or biographical profile highlighting the nominee’s qualifications.
 Incomplete or faxed nominations will not be accepted. All nominations will become the official property of the
  AGD.
 Nominations received after the deadline will be considered for the subsequent year.


Categories
Albert Borish Award—named in honor of an AGD leader and faculty member of Temple University Dental School,
who was blind; yet exhibited courage in the face of adversity and was one of the foremost experts on continuing
dental education.

Eligibility
 Nominations may only be submitted by an active AGD member.
 A member or non-member, dentist or non-dentist is eligible for nomination.
 Individuals who hold a position on the Board of Trustees are not eligible for nomination.
 Award will not be given to the same individual more than once; therefore, past recipients are not eligible for
  nomination.
 Has demonstrated dedication to the dental profession.
 Has been an innovator and a leader making positive changes.
 Has demonstrated tenacity of purpose in pursuing idealist goals which benefit the profession and public.

Criteria
 Exhibits courage in the face of adversity.
 Dedication far beyond the average to the advancement of the profession.
 Tenacity of purpose in carrying out goals and ideals.
 Innovative in the promulgation of constructive programs.
 Selflessness.
 Has deep interest in all facets of dentistry.




                                                                          1
Distinguished Service Award—acknowledges the outstanding service and leadership of an AGD council,
committee or task force member, whose contributions result in significant and fundamental advances towards fulfilling
the organization’s overall mission.

Eligibility
 Nominations may only be submitted by an AGD officer, trustee, regional director, or council, committee or task
  force member.
 Nominee must be current or past council, committee or task force member.
 Individuals who hold a position on the Board of Trustees are not eligible for nomination.
 Award will not be given to the same individual more than once; therefore, past recipients are not eligible.
 Has made contributions that have advanced the work of the AGD in a measurable and tangible way.
 Has demonstrated exemplary dedication to the organization.
 Has been an innovator and leader in making positive changes for the benefit of the membership and dental
  profession.

Criteria
 Nominee must have made the contributions being recognized by the award while serving the AGD in an appointed
  (not elected) position. The candidate will usually have made these contributions while serving as a member of a
  standing or ad hoc committee or council, or as a presidential appointee for a specialized liaison or representative
  function.
 The nominee shall have made specific, individual contributions that have resulted, or will result, in very significant,
  positive, and long-term enhancement of the goals and/or mission of the AGD.
 The nominee shall have contributed time and effort above and beyond that required by his or her fulfillment of a
  council, committee or task force appointment.


Humanitarian Award—recognizes an individual dentist who demonstrates humanitarianism, through contributions of
voluntary service, leadership in areas of civic involvement, and the delivery of quality dental care.

Eligibility
 Nominations may only be submitted by an active AGD member.
 Nominee must be an active member in good standing within the organization.
 Individuals who hold a position on the Board of Trustees are not eligible for nomination.
 Award will not be given to the same individual more than once; therefore, past recipients are not eligible.

Criteria
 Is the nominee an exemplary member of the dental profession and of his or her community?
 Has the nominee sacrificed his or her own interests in order to serve the public?
 In general, the humanitarian should possess the following traits: (kind, compassionate, concerned, thoughtful,
  sensitive, charitable, helpful, devoted, dedicated, attentive, unselfish, progressive, service-oriented, efficient,
  professional, and dedicated to excellence).
 Does the nominee exhibit a sense of responsibility toward the well being of mankind?
 How does the nominee bring honor to the dental profession through his or her accomplishments?




                                                             2
                    Academy of General Dentistry Nomination Form
                    2013 Achievement Awards

                     Please complete and return this form with all supporting documentation by
                     November 1, 2012. Nominations should be submitted to the following address:

                     AGD Awards Committee
                     Office of the Executive Director
                     211 East Chicago Avenue, Suite 900
                     Chicago, IL 60611-1999
                     E-mail: executiveoffice@agd.org
                     Phone: 888.243.7392, ext. 4330


Select the appropriate award category consistent with the nominee’s accomplishments.
    Albert L. Borish Award
    Distinguished Service Award
    Humanitarian Award


Name of Nominator: _____________________________________________________________________
Contact Address: ________________________________________________________________________
Office: _____________________________________ Fax: _______________________________________
E-mail: ________________________________________________________________________________
Signature: _____________________________________________________ Date: ___________________


Name of Nominee: ______________________________________________________________________

Title/Position: __________________________________________________________________________

AGD Member: Yes _____         No _____    AGD #: ____________________

Designations/Professional Degrees/Certifications: ______________________________________________

Constituent/Organization: _________________________________________________________________

Contact Address: ________________________________________________________________________

Office: _____________________________________ Fax: _______________________________________
E-mail: ________________________________________________________________________________


Please answer the following questions.

1.   How are you involved in the activities of the nominee?

2.   If the nominee is an AGD member, describe his or her service to the AGD on a constituent and/or national
     level.

3.   What leadership qualities has the nominee displayed?

4.   Explain the nominee’s service to the overall dental profession.

5.   How has the nominee served as an inspiration to his/her colleagues?

6.   Name other reasons the nominee should be considered for an AGD Achievement Award?




                                                        3

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:1
posted:9/13/2012
language:Unknown
pages:3