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Washington State Dental Association

2017 CITIZEN of the Year
Nomination Form

    The WSDA’s Citizen of the Year award is given to the member who has performed outstanding service, which serves to help a community in need, reinforce the value of service to the dental community, and promote the image of dentistry. The coveted award is the highest honor the association can bestow on one of its own.   
    This year, the WSDA Board of Directors voted to expand qualifying service to include work done on behalf of an employer or in a practice. Additionally, because charity begins at home, the board decided that priority would be given to dentists performing good works here in the state.
    Last year, Dr. Loree Bolin was the WSDA’s Citizen of the Year. Read Dr. Loree Bolin's story.
    If you know someone like Dr. Bolin who has given selflessly, please nominate them for this important recognition of good work. Apply below.

Criteria for nomination:
• The nominee must be a WSDA member

• The award will be based on civic activities,
elective and  volunteer, including, but not limited to:

Service organizations
Youth groups
Non-salaried government positions
Church-sponsored community services
Personal commitment to community service through    volunteering
Service to all 501(c)(3) Foundations

• Priority will be given to nominees whose service has been in Washington state

• Nominations may be made by an individual member or a component dental society. Former nominees may be  renominated. Letters of support from organizations with which  the candidate has been involved are encouraged.

• Nomination deadline: The first Friday in June of each year (June 2, 2017)

Dentists, dental team members and component society executives are now invited to nominate a WSDA member dentist for the 2017 award. The deadline for nominations is June 2. Forms and award guidelines are available from component society secretaries and executive directors, or the WSDA office.















• Selection of the state award winner will be made by the Task Force on Recognition of the Washington State Dental Association


2017 Citizen of the Year Award
This year the award will be presented at the Citizen of the Year Award banquet held during the annual House of Delegates meeting on Friday, September 15 at Skamania Lodge in Stevenson, WA. We hope you'll join us in recognizing the good works of one of your own.

Nominee's Name *
Nominee's Name
Nominee's Office Address
Nominee's Office Address
Special civic and charitable activities and/or accomplishments: (Please list with pertinent details and dates)
Please explain why you believe your nominee should receive this award.
Nominated By *
Nominated By
Phone *
Please check one · I am a: *