UMKC Dental Hygiene Alumni Association
Award Nomination Form

Nominee’s Biographical and Contact Information:
Full Name:
Class Year (if applicable):
Home Street Address:
Position or Title:
E-mail Address:

Award (Please Check):

Reaching Out for Excellence in Dental Health - Purpose:  To honor a person(s) or and organization(s) who has/have had a positive impact on the community through their time and extraordinary commitment.

Susan Brockmann-Bell Humanitarian Award - Purpose:  To honor an individual(s) and/or organization(s) who has/have demonstrated a humanitarian spirit through their commitment to improving the quality of life of patients and/or the community.

UMKC Alumni Achievement Award - Purpose:  To give recognition to alumni who have distinguished themselves in their profession and community, reflect credit on the education programs of the university, inspire and encourage alumni of the University to make outstanding contributions to society, and promote a bond of fellowship, stimulate interest, and loyalty among alumni of the University.

Additional Information suggested for Nominee to be considered:
Description of Nominee’s Achievements/Accomplishments

Supporting Documentation – Please email a copy of the Nominee’s resume, curriculum vitae or other appropriate evidence (magazine articles, etc.) documenting nominee’s accomplishments to Lonna Sletto at  Please reference your nominee in your message.

Nominator Information:

Home Address:


Daytime/Evening Phone:
Email Address: