TDA Officer Application Form

Thank you for your interest in serving in a TDA leadership position. Please complete the form below.

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* 1. Please provide your name

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* 2. Which position are you applying for?

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* 3. Please list qualifications for position (leadership roles, experience, etc.)

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* 4. Please list boards, committees or other groups you currently or previously have served on (dental or non-dental) along with years of service.

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* 5. Please share any accomplishments while serving in other leadership positions.

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* 6. Have you participated in continuing education or training programs in leadership? If yes, please share your experience.

Yes (please specify)

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* 7. Do you think there is value in the tripartite membership structure (ADA/TDA/District)? Why or why not?

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* 8. The mission of TDA is to “Help dentists succeed and support the advancement of the health of the public.”

Do you believe that the association is fully utilizing its resources to fulfill this mission? If yes, share why. If no, what additional actions would you propose?

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* 9. What are the biggest challenges you see for the TDA as an organization in the coming years and what are ways you suggest the TDA can meet those challenges?

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* 10. Please provide any additional information you would like to share.

NOTE: In addition to submitting this form, please send your headshot and completed conflict of interest form to Amy Williams via email at amy@tndental.org.

TDA Officer Application Form

Question Title

* 1. Please provide your name

Question Title

* 2. Which position are you applying for?

Question Title

* 3. Please list qualifications for position (leadership roles, experience, etc.)

Question Title

* 4. Please list boards, committees or other groups you currently or previously have served on (dental or non-dental) along with years of service.

Question Title

* 5. Please share any accomplishments while serving in other leadership positions.

Question Title

* 6. Have you participated in continuing education or training programs in leadership? If yes, please share your experience.

Question Title

* 7. Do you think there is value in the tripartite membership structure (ADA/TDA/District)? Why or why not?

Question Title

* 8. The mission of TDA is to “Help dentists succeed and support the advancement of the health of the public.” Do you believe that the association is fully utilizing its resources to fulfill this mission? If yes, share why. If no, what additional actions would you propose?

Question Title

* 9. What are the biggest challenges you see for the TDA as an organization in the coming years and what are ways you suggest the TDA can meet those challenges?

Question Title

* 10. Please provide any additional information you would like to share.

* 8. The mission of TDA is to “Help dentists succeed and support the advancement of the health of the public.”

Do you believe that the association is fully utilizing its resources to fulfill this mission? If yes, share why. If no, what additional actions would you propose?