FDA President-elect Application

FDA President-Elect 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
Name*

First NameLast Name
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone*
Please enter a valid phone number.
Office Phone
Please enter a valid phone number.
ADA Number*
Email*
example@example.com
Preferred Method of contact:*

Cell/Home PhoneOfficeEmail
Please review the current Board of Trustees recommended qualifications and job description as well as the attendance policy.

President-elect Job Description
I have read and understand the job description, duties and attendance policy for the President-elect.

YesNo
Do you have any concerns about meeting the requirements of these office?

YesNo
If yes, please explain.
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.

YesNo

Please list your qualifications for this position. (Leadership roles, experience, skills, additional training, etc.)*
Please share your goals and objectives, during your term, if you are elected President-elect of the FDA.*
Please list any boards, committees or other groups you currently or previously have served on (dental or non-dental) along with years of service.*
Please share any accomplishments while serving in other leadership positions.*
Have you participated in continuing education or training programs in leadership and/or governance? If yes, please share your experience.*
Do you think there is value in the tripartite membership structure (ADA/FDA/Component)? Why or why not?*
The mission of the FDA is to "Help Members Succeed". Do you feel that the association is fully utilizing its resources to fulfill this mission? If yes, share why. If no, what additional actions would you propose?*
What are the biggest challenges you see for the FDA as an organization in the coming years and what are ways you suggest the FDA can meet those challenges?*

Technology Expectations

Board communications and Board meeting materials are provided electronically. FDA's technology expectations include:

- High-speed internet capability

- Access to email correspondence and response on a timely basis

- Ownership or willingness to purchase a laptop computer or tablet

- Access to a current version of Adobe Reader

- Ability to open and use Microsoft Teams
*We want to assess your current level of technological capabilities so that training can be scheduled if necessary. Are you amenable to training?*

YesNo
Please provide any additional information you would like to share.
Should be Empty:

FDA President-Elect Application

Please review the current Board of Trustees recommended qualifications and job description as well as the attendance policy.

Please review and acknowledge each of the following documents.

Technology Expectations