Dental Connections Scholarship

Applicant Contact Information for the Dental Connections Scholarship

Name
Mailing Address
City
State
Zip
Email
Dental Hygiene School
Year of Graduation
ADHA/WSDHA ID Number

Family Information

Marital Status
 Married
 Divorced
 Widowed
 Partnered
 Other
Number of Dependents
Previous Occupations

Financial Information

Source of funding for first year of dental hygiene education. (Please list amounts)

Savings
Personal Loans
Work
Spouse or Family
What is your current plan to finance your second year of education? Include financial total from each planned source. Include anything you feel is important on this issue.
During your current year, have you been the recipient of any scholarships, awards, grants, financial aid or educational loans?
 Yes
 No
Please list name, amount and if it will continue this next year
Please identify any other financial aid for which you are applying to assist you in financing your second year of dental hygiene school (include the amount)

Scholastic Information

List all the schools you have attended post high school. (Include a transcript from each school, with cumulative GPA. These do not need to be certified copies.)

Personal and Professional Goals

Please submit a brief essay that addresses the following:
A. Describe why you are pursuing a career in dental hygiene.
B. Describe your most important campus activities: include honors, awards and special projects.
C. Describe your extracurricular activities, volunteer work or public service.

Three letters of reference required with application; one must be from a dental hygiene instructor.


Deadline for Application: March 15 at 10:00 am

Send to: Dental Connections
c/o WSDHA
     PO Box 389
     Lynnwood, WA 98046 or fax to 425-771-3201 or scan and e-mail: wsdha@comcast.net

Before submitting this form, please click on the link below to move the contents of box "A" into box "B" leaving the first box empty.

A: B: Click to Move