FDA Trustee Application

  • FDA Trustee Application

  • The content of this application will be sent to the FDA's Search Committee and if approved will be forwarded to the FDA's House of Delegates. 

    Applications for the June 2026 elections are due on April 3, 2026

     

    Please note that if you are chosen as a candidate you will be required to attend the June House of Delegates (HOD) meeting on June 26-27, 2026 in Orlando, FL to give a speech to the HOD.

     For additional information or questions on the nomination process, please contact Casey Stoutamire at cstoutamire@floridadental.org or (850) 681-3629

     

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  • Format: (000) 000-0000.
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  • Please review the current Board of Trustees recommended qualifications and job description as well as the attendance policy.

     

    Job Description - At-large Trustee

     

     

  • I have read and understand the job description and attendance policy for the Board of Trustees.*
  • Do you have any concerns about meeting the requirements of a Trustee?*
  • Are you able to attend the Wednesday, May 7, 2025, Virtual Candidate Form from 6:30-8:00 p.m. EST?*

  • Please review and acknowledge each of the following documents.

     

    House of Delegates Manual (includes campaign guidelines)

    Board of Trustees Code of Ethics

    FDA Whistleblower Policy

    Social Media & Email Protocol for Trustees

    Conflict of Interest Policy

    *Please complete & sign the conflict of interest policy using the link above

     

  • I have read and understand the above documents.*
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  • Technology Expectations

    Board communications and Board meeting materials are provided electronically. We want to assess your current level of technological capabilities so that training can be scheduled if necessary. Please use the checkboxes below to select your current level of technology.

  • Do you currently have: (check all that apply)*
  • *FDA staff can work with you to get you up to speed on technology needs if necessary. Are you amenable to training?*
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  • If a special election is needed due to a vacancy in an at-large trustee position, I would like to run for that position.*
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