Abstract Submission Form

To submit your application, please complete the form below:

 An ASTERISK * denotes a required field.
First Name:*
Last Name:*
Organization:*
Email:*
HRSA Region:*
 Region I
 Region II
 Region III
 Region IV
 Region V
 Region VI
 Region VII
 Region VIII
 Region IX
 Region X
HRSA Regions:
Region I (CT, MA, ME, NH, RI, VT)
Region II (NJ, NY, PR, VI)
Region III (DC, DE, MD, PA, VA, WV)
Region IV (AL, FL, GA, KY, MS, NC, SC, TN)
Region V (IL, IN, MI, MN, OH, WI)
Region VI (AR, LA, NM, OK, TX)
Region VII (IA, KS, MO, NE)
Region VIII (CO, MT, ND, SD, UT, WY)
Region IX (AZ, CA, HI, NV)
Region X (AK, ID, OR, WA)
Category:* Choose one from the list provided.

Successful innovations as part of the HRSA Health Disparities Collaboratives that have integrated oral health strategies with primary care
Models for developing New Dental Programs
Effective Clinical Management and Quality Improvement Strategies
Successful Linkages with Dental Schools, Residencies or other Community/State programs
Successful programs that provide oral health care to Homeless Populations
Effective Oral Health Prevention Programs
File:*

Agreement
To be signed by the Chief Executive Officer, President, or equivalent in organization responsible for the application

By submitting this application, we agree that if our program/system is selected, a representative of our organization will be available to present at the National Primary Oral Health Care Conference, and will be available to consult with other programs that wish to replicate/adapt your model/best practice. BPHC is granted permission to include the information supplied in this application in a Compendium, Database, or Web site.

I understand that this application is subject to the Freedom of Information Act and may be released at the written request of a member of the public.

Electronic Signature (Please place your initials in the box.)* 


*Having problems submitting your abstract?
Send an email to: 2007oralhealth@psava.com or call Desha Anderson at (703) 234-1713.
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