Tobacco Cessation Workshops
Application form
Eligibility
Any FDI Regular or Associate Member National Dental Association (NDA) is eligible to apply.
In 2024, a maximum of seven NDA workshops can be supported. The selection will be made by the FDI
Public Health Committee based on the information provided in the application form and considering country
priorities in terms of tobacco use prevalence and risk factors for oral health.
NDAs that have participated in the FDI pilot Tobacco Cessation Workshop in December 2021 or in one ofthe workshops conducted by the FDI Tobacco Cessation experts are in a favorable position when applying
for the workshop implementation grant.
The workshops
The FDI Tobacco Cessation project was launched in 2020 to provide dentists and dental teams with smoking
cessation and control resources that can be implemented in the dental setting. FDI has produced a Tobacco
Cessation Guide (available in English, French, Spanish, Arabic and Japanese) and video animations for Oral
Health Professionals which present how to deliver a three-to-five-minute intervention in the dental setting tohelp a tobacco user make a quit attempt.
To support this initiative, member NDAs can apply for a grant of CHF 1 000 to implement a Tobacco
Cessation Workshop in their country. The aim of the workshops is to educate and train a selected number oforal health professionals to apply the guidance and deliver tobacco cessation advice to patients in theirpractices.
FDI has developed a Tobacco Cessation Workshop package that can be used and, if needed, adapted byNDAs to facilitate the workshops.
Workshop participants should meet the following requirements:• Recognize that smoking cessation is part of the practice of dentistry.
• Be interested in helping tobacco users to quit their smoking habit.
• Be able to communicate fluently in English.

Completed application forms must be returned to nnoestfowler@fdiworlddental.org

FDI Tobacco Cessation Workshops:
Application form

www.fdiworl dd en tal .o rg
1Section A: About the applicant
Name of the national dental association

FDI membership status
Regular member

Associate member

Key contact person (responsible for leading the workshop)
NAME
POSITION IN ORGANIZATIONADDRESSTELEPHONE
E-MAIL

Section B: About the workshop
Details
LOCATIO N / VENUE:PROPOSED DATE:ANTICIPATED NUMBER OF PARTICIPANTS:PARTICIPANT PROFILES:(E.g. dentists, dental teams, govern m en t represe nt ati ve s,internatio n al organizati o ns, NGOs)

BACKGROUND INFORMATION:
Provide some information / data on tobacco use,consequences, and any national control policies in yourcountry.

BUDGET: please explain how the budget
will be spent

FDI Tobacco Cessation Workshops:
Application form

www.fdiworl dd en tal .o rg
2

Do the standard FDI workshop programme
and material need adapting to be used for aworkshop in your country?
Can a virtual attendance of FDI Tobacco
Cessation experts be facilitated byproviding the necessary tools andequipment?
Have you or other representatives fromyour NDA participated in the FDI pilot
workshop in December 2021 or in one of
the workshops conducted by the FDI
Tobacco Cessation experts? Please
specify.

FDI Tobacco Cessation Workshops:
Application form

www.fdiworl dd en tal .o rg
3Section C: Workshop implementation teamIdentify all stakeholders involved in the workshop organization and implementation, e.g. NDA
representatives, WHO representatives.
Member 1
NAME
ORGANIZATIONROLE AND RESPONSIBILITIESTELEPHONE
FAXE-MAIL

Member 2NAMEORGANIZATIONROLE AND RESPONSIBILITIESTELEPHONE
FAX
E-MAIL

Member 3
NAME
ORGANIZATIONROLE AND RESPONSIBILITIESTELEPHONE
FAX
E-MAILFDI Tobacco Cessation Workshops:
Application form

www.fdiworl dd en tal .o rg4Member 4
NAME
ORGANIZATIONROLE AND RESPONSIBILITIESTELEPHONE
FAX
E-MAIL

Member 5
NAME
ORGANIZATIONROLE AND RESPONSIBILITIESTELEPHONE
FAX
E-MAIL

Member 6
NAME
ORGANIZATIONROLE AND RESPONSIBILITIESTELEPHONE
FAXE-MAIL

FDI Tobacco Cessation Workshops:Application form

www.fdiworl dd en tal .o rg
5Section D: Declaration of intent
I confirm that I am authorized to sign this declaration on behalf of my National Dental
Association (NDA) and that the information provided in this form is accurate, to the best ofmy knowledge.
If the application is successful, the NDA will only use the grant for the purposes specified in
the current workshop proposal.
The NDA is obliged to respond to a post-workshop survey provided by FDI to evaluate the impact ofthe workshop on a national level. The NDA is further obliged to distribute and collect a postworkshop survey provided by FDI to all workshop participants and to provide FDI with the survey
results.

TITLE

DATE

FIRST NAMELAST NAMEPOSITION IN ORGANIZATIO N

SIGNATURE

FDI Tobacco Cessation Workshops:
Application form

www.fdiworl dd en tal .o rg
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