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The information that you post here can either be about how you serve as a mentor (self-nomination) or as someone who was mentored (nominating your mentor for the Mentor of the Year award).

* 1. How did you meet your mentor? Although more than one option may apply, choose the relationship most relevant to the mentoring aspect of your relationship with your mentor.

* 2. In no more than 75 words, please state how long, and in what roles, your mentor has been a professional health care provider in dentistry?

* 3. For how long have you been a dental hygienist?

* 4. Did your mentor ... (More than one option may apply. Please choose the one that best describes the mentoring relationship)

* 5. What benefits did you derive from your mentor? (choose all that apply)

* 6. How long did the mentoring relationship last?

* 7. Has the experience of you being mentored led you to mentor someone else?

* 8. In what type of setting is your experience as a dental hygienist currently being used?

* 9. In no more than 150 words, please tell us the primary way your mentor has inspired you?

* 10. How can we contact you if we have more questions?

* 11. What is the best way to contact your mentor?

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