ࡱ> @B? &bjbj|| @(}g}g 88888LLL8,<Ll$!8)^88'&^88j<0lP"OP"P"8%lP"X : PROSPECTIVE GRADUATE FORM Congratulations on your impending graduation and welcome to the dental hygiene profession. The purpose of this form is to help the Ohio Dental Hygienists' Association be aware of all new graduates. We would like to be of service to you and also have the nearest Component Association welcome you to the organization. In order to do this, we need the following information. PLEASE GIVE US THE ADDRESS WHERE YOU CAN BE REACHED AFTER GRADUATION: NAME: ADDRESS: CITY: STATE: ZIP: PRIMARY PHONE: OTHER PHONE: PERSONAL EMAIL:  SCHOOL: STUDENT CHAPTER OF ADHA MEMBER ID# CAN WE SEND YOU TEXT MESSAGES? YES NO CAN WE SEND YOU EMAIL? ______YES ________ NO BEST WAY TO CONTACT YOU? EMAIL TEXT PHONE CALL PLEASE CHECK THE AREA(S) WHERE YOU PLAN TO BE EMPLOYED AND/OR ATTEND COMPONENT MEETINGS. ___ Cincinnati ___Northwestern ___ Cleveland ___Stark ___ Columbus ___ Toledo ___ Dayton ___ Tri-County ___ Northeastern ___ Another state-if so what state?________________________ Thank you for your cooperation and again, congratulations upon entering your chosen profession. We hope you become an active member of the American Dental Hygienists Association and the Ohio constituent, the Ohio Dental Hygienists Association. Your excitement and enthusiasm for dental hygiene is an asset to an already vital profession. Please have the Student Chapter Advisor (or Program Director) send all prospective graduates forms together, and mail to: Katharyn Buckingham, RDH PO Box 352 McComb, OH 45858  HYPERLINK "mailto:Crawford.kat13@hotmail.com" Crawford.kat13@hotmail.com     Rev., 2/08 v          $ % & ' 0 7 d e f g ˺ܺ˕܄˕ܕ˕s h#-hCJOJQJ^JaJ h#-hxCJOJQJ^JaJ h#-hBCJOJQJ^JaJ&h#-hu6>*CJOJQJ^JaJ h#-huCJOJQJ^JaJ h#-hq7CJOJQJ^JaJ h#-h2CJOJQJ^JaJ#h#-hu5CJ OJQJ^JaJ - ixkd$$Ifl0(5% t04)644 la $Ifgd2$a$gdBgd2$a$gd2   ~~~~~~~~~ $Ifgd2xkd}$$Ifl0(@ t04)644 la      ;222 $Ifgd2kd$$Iflֈ!(K  t04)644 la  $ % & ' 7 e OF $Ifgdkd$$Ifl\((  t04)644 la $Ifgd2 $IfgdBe f g o ~~~~ $Ifgd2xkdH$$Ifl0( t04)644 lag o    % & * + c d ޲uudddddS h#-hnCJOJQJ^JaJ h#-hMCJOJQJ^JaJ4jh#-hMCJOJQJU^JaJmHnHu h#-hBCJOJQJ^JaJ h#-hq7CJOJQJ^JaJ h#-hCJOJQJ^JaJ4jh#-hxCJOJQJU^JaJmHnHu h#-hCJOJQJ^JaJ h#-h2CJOJQJ^JaJ + d  / J g }}}gdq7gd2xkd$$Ifl0( t04)644 lad   / J [ \ g w [ \ ] ~  ޼޼滛teSS#h-dh6CJOJQJ^JaJh#Q6CJOJQJ^JaJ#h-dhB6CJOJQJ^JaJ#h-dhPE6CJOJQJ^JaJ#h-dhA86CJOJQJ^JaJ#h-dhUz"6CJOJQJ^JaJ h#-h(LCJOJQJ^JaJ h#-huCJOJQJ^JaJ h#-hq7CJOJQJ^JaJ h#-hA8CJOJQJ^JaJ     #$%&$a$gdu$a$gd,U$a$gdUz"$a$gd|6gdA8$]^a$gdgd2  6K`i±£•ufuTuE1u&jh#Q5CJOJQJU^JaJh-d5CJOJQJ^JaJ#hUz"h#Q5CJOJQJ^JaJhUz"5CJOJQJ^JaJh#Q5CJOJQJ^JaJ h|6hBCJOJQJ^JaJhUz"CJOJQJ^JaJh??CJOJQJ^JaJ h2hnCJOJQJ^JaJ h2huCJOJQJ^JaJhBCJOJQJ^JaJh/fCJOJQJ^JaJ h-dhBCJOJQJ^JaJ    "#$%&ɷhuhuhuCJ aJ hBCJ aJ hPECJ aJ huCJ aJ h5jh5U#hUz"h-d5CJOJQJ^JaJh#Q5CJOJQJ^JaJ'h=:h#Q0J5CJOJQJ^JaJ&jh#Q5CJOJQJU^JaJ> 00P:pB/ =!"#$% <Dp{$$If!vh#v#v5%:V l t04)6555%{$$If!vh#v#v@ :V l t04)655@ $$If!vh#vK#v #v#v#v#v :V l t04)65K5 5555 $$If!vh#v(#v #v#v :V l t04)65(5 55 {$$If!vh#v#v :V l t04)655 {$$If!vh#v#v :V l t04)655 x666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@66666_HmH nH sH tH P`P Normal1$7$8$H$OJQJ^J_HmH sH tH DA D Default Paragraph FontRi@R  Table Normal4 l4a (k (No List vv 2 Table Grid7:V01$7$8$H$44 uHeader  !4 @4 uFooter  !H"H PE Balloon TextCJOJQJ^JaJ6U`16 #Q0 Hyperlink >*B*phcPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vj\{cp/IDg6wZ0s=Dĵw %;r,qlEآyDQ"Q,=c8B,!gxMD&铁M./SAe^QשF½|SˌDإbj|E7C<bʼNpr8fnߧFrI.{1fVԅ$21(t}kJV1/ ÚQL×07#]fVIhcMZ6/Hߏ bW`Gv Ts'BCt!LQ#JxݴyJ] C:= ċ(tRQ;^e1/-/A_Y)^6(p[_&N}njzb\->;nVb*.7p]M|MMM# ud9c47=iV7̪~㦓ødfÕ 5j z'^9J{rJЃ3Ax| FU9…i3Q/B)LʾRPx)04N O'> agYeHj*kblC=hPW!alfpX OAXl:XVZbr Zy4Sw3?WӊhPxzSq]y &( g d &   e & &X8@(  D    "?D   "?D   "?B S  ??` & 4)tTtLt  $'Xc  $'333[\w       "$'[\w      !"$'763.P1InB@dUz"#-L*0t2|6A8E :~<??XC0fCPEeI(L#Q?U{{X&!a-dshhNi& nu^wfwz?:=q7[xe#O_u5YM2]'3U /f,U  @&@UnknownG.[x Times New Roman5Symbol3. .[x Arial7..{$ Calibri5. .[`)TahomaC.,.{$ Calibri LightA$BCambria Math"hJGJG,   !xx23QP?22!xxGmV PROSPECTIVE GRADUATE FORMakuntzsusan johnston Oh+'0 , L X d p|PROSPECTIVE GRADUATE FORMakuntzNormalsusan johnston2Microsoft Office Word@@<Š@ @   ՜.+,D՜.+,T hp  Stark State College  PROSPECTIVE GRADUATE FORM Title 8@ _PID_HLINKSA|`"mailto:Crawford.kat13@hotmail.com  !"#$%&'()*+,-.012345689:;<=>ARoot Entry F1CData 1TableP"WordDocument@(SummaryInformation(/DocumentSummaryInformation87CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q