100 MMC Application, 2023-24

Thank you for your interest in applying to be an Oral Health Education Champion.

Because we believe that people of color, indigenous people, people from working-class backgrounds, women, and LGBTQ+ people must be centered in the work we do, we strongly encourage applications from people with these identities or who are members of other marginalized communities.

Thank you!

Your name:

Credentials:

Gender:

Ethnicity:

Race:

State you are applying from:

Email address:

* must provide value

How did you hear about recruitment of OH Champions?

I received the flyer in email

From a colleague

From a newsletter/announcement, please specify which one:

One of the current champions or Advisory Board members recommended me

Other

Please list your current positions:

Organization:	Role:

Please attach your CV:

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Please answer the following questions:

Why do you want to be your state Oral Health Education Champion and engage health profession schools/programs to learn more about oral health? (up to 250 words)

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What experiences do you have engaging/teaching primary care learners and professionals about oral health? (up to 250 words)

* must provide value

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As an Oral Health Education Champion, how might you contribute to improving health equity in the population(s) you work most closely with? Please include examples of previous health equity work (up to 250 words).

* must provide value

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