2026 Future Leader in General Dentistry Award Survey

First Nomination

The AGD Future Leader in General Dentistry Award recognizes up to two senior dental students from each dental school in the United States, Canada and Puerto Rico who exhibit potential for becoming outstanding general dentists. The information submitted through this form will be used on the award certificate and to recognize awardees. More details on the award criteria can be found at www.agd.org/FLGDA.

Please note:

All individuals being nominated must be an AGD member to receive their complimentary membership in the year following graduation.
AGD constituents are to administer the selection of the award winner in collaboration with their local dental school’s AGD student chapter faculty advisor. When constituent and/or faulty advisor assistance is not available, the school of dentistry administration can administer the selection.

Nomination forms close March 6, 2026.

1.What is your name and relation to the dental school?(Required.)

2.Dental school name (Enter the full institution name, exactly as it is meant to appear on the award certificate):(Required.)

3.Date to appear on certificate:(Required.)

4.Was an AGD member part of the selection process?(Required.)

Yes

5.STUDENT AWARDEE CONTACT INFORMATION – required information

In an effort to ensure awardees receive information regarding their membership from AGD Headquarters, all persons completing the application must provide the awardee’s contact information. If the information below is not provided, this application will not be processed. The AGD will not contact the awardee until after they have been presented the award.(Required.)

Name:

Designation (DMD or DDS):

AGD ID:

Address line 1:

Address line 2:

City, State:

Zip/Postal Code:

Personal e-mail:

School e-mail:

6.This award recognizes up to two senior students from each dental school who exhibit potential for becoming outstanding general dentists. Would you like to nominate a second student?(Required.)

Yes