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:______________