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* 1. Name

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* 2. Email Address

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* 3. Graduation Year

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* 4. Chapter

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* 5. Did you attend the 2018 ADA Dentist and Student Lobby Day?

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* 6. Did you join ADPAC between April 2018 and January 2019?

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* 7. Did you attend at least one session in the advocacy track at ASDA's 2018 National Leadership Conference?

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* 8. Indicate if you attended the national advocacy webinars held this year.

  Yes No
Advocacy 101 (Sept. 18, 2018)
Combating the Opioid Epidemic (Nov. 13, 2018)

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* 9. Report the Engage Action Alerts you've sent.

  Yes No
Action for Dental Health Act (H.R. 2422)
Student Loan Refinancing and Recalculation Act (H.R. 4001)
Student Loan Refinancing (H.R. 1614)

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* 10. Did you write an advocacy-related article or blog post for Contour or Mouthing Off?

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* 11. Share the title of your advocacy-related article(s) or blog post(s) that was published.

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* 12. How many local, chapter or district advocacy events did you attend between April 2018 and January 2019? (Enter a whole number only.)

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* 13. List the local, chapter or district advocacy events you attended (include the event date and title).

T