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List all academic degrees, including the name of degree, university, city and state.
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List all past positions starting with most recent, including the date range, job title, name of company or organization, city and state.
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Can we use the positions listed above publicly when sharing information about our members?
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Name of the NCDHE member who referred you.
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Each of us is committed to improving health equity, especially oral health equity by means of evidence-based measures and/or by means of sharing innovations that are measured and documented. All members commit to the principles of social justice and racial equity in health policies and practices and believes that every American deserves the right to have the achievable opportunity for health regardless of race, income, education, abilities, or sexual orientation. One example of this is that members commit to the equitable inclusion of oral health in all local, state, and national primary health care policies, whether they are financing, such as Medicare, Medicaid and Federally Qualified Health Centers legislation etc. or disease driven such as policies for the prevention, detection or remediation of cancer, diabetes, and others. Another example of the above is that each of us is responsible to be aware of the global and US history and experience with the care provided by dental therapists, their scope, quality, education, supervision, and the cost effectiveness when utilized in private practice, FQHCs and other nonprofit programs and support state adoption of dental therapy legislation that incorporates the standards established by the Commission on Dental Accreditation. What are we asking members to do? Primary Responsibilities are 1. Be familiar with and fully support the NCDHE position statements and 2. Be prepared to engage in advocacy to support the Mission, Vision and Values. Do you accept these responsibilities as a member of NCHDE?
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I will participate in the business of the organization either providing administrative or content support
I will testify at public hearings, sign letters to the editor and Op-eds
I will participate in or be supportive of a speaker’s bureau
I will respond to media requests following agreed upon media protocols
I will participate in webinar training and conduct or participate in educational sessions for community groups, health professionals and advocates for the underserved, etc.
I am willing to write white papers
I will assist in writing grant proposals
I will seek out and recommend other ways for NCDHE to increase visibility and gain public and policy maker support
I will participate in the business of the organization either providing administrative or content support
I will testify at public hearings, sign letters to the editor and Op-eds
I will participate in or be supportive of a speaker’s bureau
I will respond to media requests following agreed upon media protocols
I will participate in webinar training and conduct or participate in educational sessions for community groups, health professionals and advocates for the underserved, etc.
I am willing to write white papers
I will assist in writing grant proposals
I will seek out and recommend other ways for NCDHE to increase visibility and gain public and policy maker support
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By submitting payment, I am authorizing National Coalition of Dentists for Health Equity to initiate a single or recurring ACH/electronic debit in the amount indicated from the bank account I designated above. I understand that this Authorization will remain in full force and effect until the transaction is cancelled by me by contacting National Coalition of Dentists for Health Equity, or the ACH/electronic debit is processed from the designated account. I certify that (1) I am authorized to debit the bank account above and (2) the ACH/electronic payment I am authorizing complies with all applicable laws.
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