SHIP Award Application
Thank you for your interest in applying for the American Academy of Dental Hygiene Inc. SHIP Award. It is named for the qualities represented by the Academy: Leadership, Fellowship, Mentorship and Scholarship. Please complete the form below to be considered for the award. Applications must be received by May 1st.
Submission requirements checklist:
Date:
*
Today's Date
Name:
*
First Name
Last Name
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
*
-
Area Code
Phone Number
Email Address:
*
Name of Institution:
*
Graduation Date:
*
Applicants should have a Spring or Summer anticipated date)
Signature of applicant:
*
Enrollment verification:
*
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Curriculum Vitae
*
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300-Word Essay
*
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