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Leadership Institute

WSDA Leadership Institute

The WSDA Leadership Institute is a program designed to foster new leadership in organized dentistry by getting participants involved in a variety of WSDA activities and meetings.

The program provides an opportunity for WSDA members, in small cohorts of five to seven participants, to gain a better understanding of organized dentistry at the state level and to build relationships with current WSDA leaders. Participants are paired with WSDA Board of Directors or Past President mentors who shepherd them through several activities tailored to developing emerging leaders from within our membership.

Leadership Institute Events

Participants should plan to attend the following events. All program costs are paid by WSDA, including airfare, hotels, meals, and transportation.

Past Presidents Roundtable & Association Orientation (Sept. 9, 2021 in Spokane)
House of Delegates (Sept. 9-11, 2021 in Spokane)
Committee Meeting(s) of Participant’s Choice (Multiple Dates)
Pacific Northwest Dental Conference (Nov. 11-13, 2021 in Seattle)
Dental Action Day (January or February 2022 in Olympia)
Board of Directors Meeting (March 4, 2022 in Seattle)

Please apply below by June 4, 2021.

Leadership Institute Application

First Name

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Last Name

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Phone Number

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ADA Number

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Where do you practice?

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What is your primary practice model?

I am the sole owner of a dentist-owned and operated practice.
I am a partner or partial owner of a dentist-owned and operated practice.
I am an owner in a practice that is operated by a dental management service organization.
I am part of a solo group practice where I am one of several dentists who own and operate their own practices.
I am an employee dentist in a dentist-owned and operated private practice.
I am an employee dentist in a practice that is operated by a dental management service organization.
I am an independent contractor who provides specific or specialty services within the practices of other dentists.
I am an employee dentist in a FQHC or military dental clinic.
I am retired.
Other.

How did you hear about the Leadership Institute?

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Please list your current and past involvement in organized dentistry.

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What are your future leadership goals within organized dentistry?

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What do you hope to achieve through the WSDA Leadership Institute?

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Please provide two references.

Reference 1 Name

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Reference 1 Phone

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Reference 1 Email

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Reference 1 Relationship

Professional
Peer

Reference 2 Name

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Reference 2 Phone

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Reference 2 Email

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Reference 2 Relationship

Professional
Peer

Leadership Institute participants are expected to attend the following events. All program costs are paid by WSDA, including airfare, hotels, meals, and transportation.

Past Presidents Roundtable & Association Orientation (Sept. 9, 2021 in Spokane)
House of Delegates (Sept. 9-11, 2021 in Spokane)
Committee Meeting(s) of Participant’s Choice (Multiple Dates)
Pacific Northwest Dental Conference (Nov. 11-13, 2021 in Seattle)
Dental Action Day (January or February 2022 in Olympia)
Board of Directors Meeting (March 4, 2022 in Seattle)

Are you able to attend the activities listed above?

Yes
No

Leadership Institute Past Graduates

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2011
Dr. Stephen Lee – Snohomish County Dental Society
Dr. Princy Rekhi – Seattle-King County Dental Society
Dr. John Lo – Pierce County Dental Society
Dr. Marissa Bender – Snohomish County Dental Society
Dr. Duane Pegg – Grays Harbor Dental Society
2012
Dr. Thomas Natale – Snohomish County Dental Society
Dr. Mark Germack – Seattle-King County Dental Society
Dr. Ashley Ulmer – Spokane County Dental Society
2013
Dr. Naghmeh Izadi – Snohomish County Dental Society
Dr. Jonathan Judd – Spokane District Dental Society
Dr. Kishore Shetty – Snohomish County Dental Society
2014
Dr. Heather Ronngren – North Central District Dental Society
Dr. Nathan Russell – Kitsap County Dental Society
Dr. Miki Suetsugu – Seattle-King County Dental Society
2015
Dr. Kristine Aadland – Clark County Dental Society
Dr. Alexis Apatoff – Snohomish County Dental Society
Dr. Ryan Fox – Seattle-King County Dental Society
Dr. Todd Irwin – Olympic Peninsula Dental Society
Dr. Joseph de Jesus – Thurston-Mason Counties Dental Society
Dr. Julie Kellogg – Walla Walla Valley Dental Society
Dr. Patty Martin – Walla Walla Valley Dental Society
2016
Dr. Imahn Moin – Seattle-King County Dental Society
Dr. Joe Vaughn – Seattle-King County Dental Society
2017
Dr. Mandy Alamwala – Mt. Baker Dental Society
Dr. Austin Baruffi – Seattle-King County Dental Society
Dr. David Houpt – Kitsap County Dental Society
2018
Dr. Emily Hobart – Mt. Baker Dental Society
Dr. Ronald Hsu – Clark County Dental Society
Dr. Amir Kazim – Spokane District Dental Society
Dr. Bakhtiar Pribadi – Snohomish County Dental Society
Mr. Brandon Walker – UW School of Dentistry (Class of 2020)
2019

Dr. Liselotte Black – Benton-Franklin Counties Dental Society
Dr. Brianne Butler – Olympic Peninsula Dental Society
Dr. Adam Kennedy – Seattle-King County Dental Society
Dr. Ivy Lin – Snohomish County Dental Society
Dr. Kathleen Stambaugh – Mount Baker District Dental Society

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