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About Us

Leadership Academy Application

Thank you for your interest in participating in the ODA Leadership Academy. All applications received by December 1, 2024, will be reviewed and notified of acceptance into the 2025 Academy by December 31, 2024.

Full Name ( i.e. John Doe, DMD)

Cell Phone Number

Office Phone Number

Email

Mailing Address (include city, state, and zip code)

Years in Practice

Practice Model - Please select all practice models you have practiced in.

Solo Practice
Private Group Practice
Dental Management Organization Affiliated Group Practice
Faculty
Public Health Provider
Other

What made you apply for the Leadership Academy

What do you hope to gain by participating

Previous Leadership Experience/Roles

(within and outside of dentistry)

Academy curriculum will be customized to the participants, based on the areas of leadership that are most important to the group. Which two areas do you want to be the focus for the 2023 class? Please select three.

Addressing Poor Performance
Business Communication
Coaching-Bringing out the Best in Others
Effective Meeting Management
Foundations of Leadership
Giving Recognition
Managing Priorities
Moving from Conflict to Collaboration
Personal Strategies for Navigating Change
The Basic Principles for a Collaborative Workplace

Please share your resume or CV:

This field is required

Please share your photo/headshot:

This field is required

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