WDHA Lona Hulbush Jacobs Memorial Scholarship Application

WDHA may award up to $1000 for the Lona Hulbush Jacobs Scholarship to a first year dental hygiene student who shows scholastic aptitude and need for financial assistance.  This award is presented at the Symposium for Oral Healthcare Professionals.  The application deadline is 4 pm on the last Friday in February. This award will be presented as funds allow.


1. Applicant shall be a first-year dental hygiene student enrolled in a Washington State dental hygiene program.
2. Applicant shall have a hygiene program cumulative GPA of not less than 3.0.
3. Applicant shall demonstrate a need for financial aid by supplying financial documentation with the application.


The scholarship will be presented to the recipient at WDHA's Annual Symposium. Applications must be received at Central Office no later than 4 pm on the last Friday in February. The 2020 deadline is February 28.


First Name
Last Name
Mailing Address
Contact Phone #
ADHA ID Number
Which Dental Hygiene Program are you attending?
Year of Graduation

Family Information


Marital Status
Number of Dependents
Previous Occupations

Financial Information

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

Personal Loans
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? 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.)
Upload your transcript 1
Upload your transcript 2

Personal and Professional Goals

Please submit (copy and paste) 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

Please provide 3 letters of reference with your application. One must be from a dental hygiene instructor. Letters can be uploaded with online application, emailed to wsdha@comcast.net, or mailed to PO Box 389, Lynnwood, WA 98046. Letters must be postmarked by 2/28/20.

Upload your reference letter 1
Upload your reference letter 2
Upload your reference letter 3
Are you attending this year's House of Delegates?
The grant will be sent directly to the institution of higher learning you are enrolled in. Please indicate the name, address and department this should be directed to if you are selected as a grant recipient:
Please type your full name below for your signature.

Deadline for Application: February 28, 2020

Only online applications will be accepted.


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