2020 Scholarship Application

LINDSEY ORTHODONTICS

2020 SCHOLARSHIP APPLICATION

 

REQUIREMENTS:

  • You MUST be a current or past patient of Lindsey Orthodontics.
  •         A 2020 graduating high school senior with a college acceptance for Fall 2020.
  •         Weighted/Cumulative GPA of 3.0 or higher.
  • Your essay must be included with this application. (details listed on page 2)
  • Completed application mailed in and postmarked by April 6th, 2020.

***Please include an official sealed copy of your high school transcript from your school counselor.

 

Failure to meet the 6 requirements above will void your application.

 

Scholarship amount to be awarded is $500.00  

(Up to 12 Scholarships within multiple schools will be awarded.)

 

Student Name: __________________________________________________________

Date of Birth: ____________________

 

Address: _______________________________________________________________

 

City: ____________________________________ State: ________ Zip: ____________

 

Telephone: ___________________ E-mail: ___________________________________

 

High School: __________________________________________

GPA: Weighted/Cumulative:  _______

 

Extra-curricular high school activities and Community Service:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

(Attach sheet if necessary)

 

Name of the college you have been accepted to or plan to attend:

__________________________________________________________________________

__________________________________________________________________________

 

Field of study: _____________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

 

 

LINDSEY ORTHODONTICS 2020 SCHOLARSHIP APPLICATION

(Page 2)

 

Future career plans: ______________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

(Attach sheet if necessary)

 

How did you hear about the Lindsey Orthodontics Scholarship Program?  (Circle)           

 (Teacher, School Counselor, Lindsey Orthodontics Employee, Lindsey Orthodontics Patient, Lindsey Orthodontics Facebook/IG page) Other: ____________________________________

 

ESSAY

 

  • Please include an essay (250- 500 words) on why you believe you should receive this scholarship. (This may include future goals, financial need, or obstacles you have overcome.)

 

  • Please send completed application postmarked by April 6th, 2020 to:

 

LINDSEY ORTHODONTICS

ATTN: SCHOLARSHIP

120 West College Street

Suite A

Griffin, GA 30224

 

STUDENT AND PARENTAL CONSENT

 

There are several opportunities for the recognition and/or publicity of the student. Lindsey Orthodontics would like to celebrate the student recipient with a visit to our office to take a photo with Dr. Charles Lindsey. The photo may be used in publicity opportunities including, but not limited to our website, Facebook, local papers/magazines, etc...

 

I give approval for my son/daughter to be photographed for the Lindsey Orthodontics

Scholarship, understanding that the photo may be posted on www.lindseyorthodontics.com,

Facebook, Instagram, local papers/magazines, etc... for student recognition.

 

Parent/Guardian Signature: ________________________________Date:____________

 

I certify that the information in the application is true, complete, and correct to the best of

my knowledge. I understand that this information is confidential and subject to

verification by Lindsey Orthodontics.

 

Student Signature: ______________________________________Date:______________