AWARDS NOMINATION FORM rev 10/2011 (Loyal Assistant Award)

AMERICAN DENTAL ASSISTANTS ASSOCIATION - AWARDS NOMINATION FORM rev 10/2011 - LOYAL ASSISTANT AWARD

A separate form MUST be submitted for EACH nomination - CONTACT ADAA CENTRAL OFFICE, please allow 2 business days for confirmation, if confirmation is not received, contact our office - do not resubmit form.

It is your responsibility to contact central office if a confirmation of receipt email is not received. This nomination form is NOT used with entries for the Student Achievement Award or Mosley Distinguished Service Award.

Letters of Recommendation - EMAIL SEPARATELY to nrod@adaa1.com (Subject:  Awards Letter of Recommendation), you will be notified when received.

PLEASE NOTE:  Notarizations, letters of recommendation, reference and other documents must be sent as a separate attachment to nrod@adaa1.com.  When submitting separate attachment, include name of Award, name of Award nominee and submitter information.

When sending forms:

  • Do not submit this form more than once for the same recipient.  If you have a question about your entry, contact Nancy Rodriguez
  • You will receive a confirmation once it has been accepted/returned for further information
  • Please use proper grammar, ADAA will not change the format of the form
  • Do not use ALL CAPS, do not use all lower case
  • REMEMBER to submit additional documentation separately

DO NOT USE THE RETURN BUTTON UNTIL YOU ARE FINISHED, THIS WILL SUBMIT YOUR FORM, COMPLETE OR INCOMPLETE

Address:
Employer's Address:

PLEASE NOTE:  Notarizations, letters of recommendation, reference and other documents must be sent as a separate attachment to nrod@adaa1.com.  When submitting separate attachment, include name of Award, name of Award nominee and submitter information.

Before clicking submit:

  • Do not submit this form more than once for the same recipient.  If you have a question about your nominee, contact Nancy Rodriguez
  • Verify use of proper grammar, ADAA will not change the format of the form
  • Do not use ALL CAPS, do not use all lower case
  • REMEMBER to submit additional documentation separately
  • You will receive a confirmation that your submission has been received