Hispanic Dental Association Foundation 2016-2017 Scholarship Program



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Hispanic Dental Association Foundation

2016-2017 Scholarship Program
The Hispanic Dental Association Foundation in its quest for continuous improvement in the development of oral health professionals presents a scholarship program to students in dentistry. Scholarships in the amount of $2,000 for Dental Students and $1,000 for Dental Hygiene Students and Dental Assisting Students and $4,000 for Dental Specialty Residents will be awarded to support meritorious work by students who seek to advance their scientific and applied clinical knowledge as they enter into the oral health profession. Scholarship amounts vary depending on Funder of Scholarship. Please refer to each scholarship description for details.
What is the intent of the scholarship?
The intent of this HDA Foundation Scholarship Program is to support promising students as they pursue their academic training. The awarding of these scholarships will support the grantees during their dental, dental residency, dental hygiene, dental assisting or dental technician programs.
Who can apply?
These scholarships are open to student members of the Hispanic Dental Association who have been accepted or enrolled into an accredited dental, dental residency, dental hygiene, dental assisting or dental technician program. Students must be a current student member of the Hispanic Dental Association.
How does one apply?
The attached application form must be submitted to the Hispanic Dental Association Foundation at the address listed at the bottom of this page. The application must be received by the Foundation no later than September 15, 2016. Application must be typed and submitted in English.
How will the scholarships be awarded?
The Scholarship Committee of the HDA Foundation will review each application on its merit. Areas that will be included are the demonstration of:


  • Commitment and dedication to improving the oral health of the Hispanic community

  • Community Service (i.e. volunteer efforts in school, medical facilities, church, etc.)

  • Leadership Skills

  • Scholastic Achievement



What is the timing of the scholarship program?
For the 2016-2017 academic year, the application must be postmarked no later than September 15, 2016. The award decisions will be final and communicated to all applicants by October 15, 2016.
Return Application for the 2016-2017 Scholarships to:
Hispanic Dental Association Foundation

3910 South IH-35, Suite 245, Austin, TX 78704

For further information, call 512-904-0252 or email support@HDAssoc.org



Hispanic Dental Association Foundation

2016-2017 Scholarship Program
SCHOLARSHIP APPLICATION INSTRUCTIONS
Thank you for applying to the Hispanic Dental Association Foundation Scholarship Program. You may be eligible to receive an award if you meet all program requirements.

Eligibility Requirements

To be considered you must:




  • Be accepted or enrolled in an accredited dental program, dental hygiene program, dental assisting program, or dental technician program in the U.S. or Puerto Rico.




  • Be a current HDA (Hispanic Dental Association) member and/or HSDA member.




  • Be a full time student during the academic year for which you are applying.




  • Have a minimum average grade point of 3.0 on a 4.0 scale or in good academic standing at your school if your dental program does not provide a GPA.




  • Show interest in improving the oral health of the Hispanic community.




  • Show evidence of commitment and dedication to serve the Hispanic community.

Please read all materials carefully. It is YOUR responsibility to ensure that ALL of the necessary materials are received at the HDA Foundation office by the deadline.


Scholarship Application Deadline

This application will be evaluated based on merit. Materials must be typed and in English. Handwritten applications will be disqualified.




  • You must submit your completed application to the Hispanic Dental Association Foundation (HDAF) postmarked no later than September 15, 2016.




  • The Verification form must be sent directly from the school to the HDAF postmarked no later than September 15, 2016. (Remember you are to complete the top of the Verification.)




  • One (1) Recommendation must be submitted directly from the Recommenders to the HDAF, postmarked no later than September 15, 2016.




  • The award decisions will be communicated to all applicants by October 15, 2016.




  • If you are a recipient of this scholarship award, you are required to write an essay for the HDA Newsletter outlining your intention to remain involved with the Hispanic Dental Association and specific ways in which you will optimize the oral health of the Hispanic community.




  • If you are a recipient of this scholarship award, you will receive an additional scholarship package that will include $500 travel reimbursement and complimentary meeting registration to attend the Greater New York Dental Meeting November 25-28, 2016, in New York City. Attendance to the meeting Scholarship Reception, November 28, from 2-5 pm, is mandatory for scholarship acceptance.


FAILURE TO HAVE ON FILE THE COMPLETED FORMS LISTED ABOVE BY THE APPROPRIATE DEADLINE DATE WILL RESULT IN REJECTION OF YOUR ENTIRE APPLICATION.
Hispanic Dental Association Foundation

2016-2017 Scholarship Program




Please Select the scholarships you are applying for (You may select more than one) :

Colgate Dental Residency or Specialty students



Colgate Dental Students - 1st, 2nd, 3rd, 4th year

Dental Hygiene students- - 1st, 2nd year
Proctor & Gamble Dental Students- 1st, 2nd, 3rd, 4th year

Dental Hygiene Students- 1st, 2nd year
HDAF Dental Students- 1st, 2nd, 3rd, 4th year

Dental Hygiene Students- 1st, 2nd year
Esperanza Rodriguez Dental Students- 2nd , 3rd year
A-dec Dental Students- 3rd, 4th year
Juan D. Villareal Texas Students Only

Dental Students- 1st, 2nd, 3rd, 4th year

Dental Hygiene Students- 1st, 2nd year


Hispanic Dental Association Foundation

2016-2017 Scholarship Program
SCHOLARSHIP APPLICATION
PLEASE READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING APPLICATION.

ALL APPLICATIONS MUST BE TYPED.


A. Program
In the Fall of 2016, I will be enrolled in the following program:
DENTAL:  DDS or  DMD DENTAL HYGIENE:  DENTAL ASSISTING:  DENTAL TECH: 
School (note year of school):

Specialty Program (if applies):_______________________________________________________________


Dean or Program Director Name:

B. General Information
Full Name:
Mailing Address:

Cell Phone #:
Email (school): Email (personal):_____________________________


C. Education (Dental Applicants – list main College and Dental school attended).
From: To: Degree Earned:
School:
From: To: Degree Earned:
School:
From: To: Degree Earned:
School:

Important: You must type on this form. If additional space is necessary, please include a separate page clearly marked.


D. Community Service and Volunteer Activities (HSDA and non-HSDA)

List student, professional association and/or volunteer experiences (with dates of participation) that include your top 10 activities in the past 4 years, with preference given to Hispanic community outreach and Hispanic oral health related activities:

































E. Leadership (HSDA and non-HSDA)

List any HSDA or other Leadership positions you have held while in or leading up to your dental program in the past 4 years. List up to 5 total:


________ ____________










F. Honors and Recognitions (HSDA and non-HSDA)

List any honors received for scholastic achievements and/or recognitions in community service, leadership and extracurricular activities while in or leading up to your dental program in the past 4 years. List up to 5 total:


________________________________________________________________________________

















G. Career Goals Statement – Essay Portion: Discuss your career goals, including how you were inspired to become a dentist, hygienist or other dental professional? How will you use the HDA SEAL mission (Service, Education, Advocacy, and Leadership) to help improve the Hispanic community when you complete your program?












































Your statement must be a maximum of 500 words, and should include your career goals, specifically pertaining to your contribution to the Hispanic community. Please use the lines above or attach to the application a separate sheet with your statement/essay typed and double spaced. Any essay more than 500 words will not be accepted.



H. Authorization
I HEREBY AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED WITHIN THIS APPLICATION. I UNDERSTAND THAT MISREPRESENTATION OR OMISSION OF FACTS IS CAUSE FOR DISQUALIFICATION.

Signature Date:

RETURN POSTMARKED NO LATER THAN Sept. 15, 2016.



HDA Foundation

3910 South IH-35, Suite 245, Austin, TX 78704



Hispanic Dental Association Foundation

2016-2017 Scholarship Program
SCHOLARSHIP APPLICATION RECOMMENDATION
Applicant must provide one Recommendation. Recommendation Checklist must be filled out and mailed to the HDAF by the person (Recommender) filling out the Recommendation.
Section to be completed by Applicant (please type):
Name of Applicant:
Address:

Applicant Signature Date:



This will notify HDA Foundation that my recommendation will come directly from:
 Dental School Faculty  Other
Name:
Company or School:
Address:

Phone:
------------------------------------------------------------------------------------------------------------------------------------------------------------


NOTE: Failure to provide one recommendation will disqualify the application.

RETURN POSTMARKED NO LATER THAN Sept. 15, 2016.



HDA Foundation

3910 South IH-35, Suite 245, Austin, TX 78704


bluehdalogo foundation
2016-2017 Scholarship Program

Recommendation

1. Knowledge of the Applicant

I have known the Applicant for ______ Year(s) ______Month(s)



(e.g., 3 years and 6 months)

2. Evaluation of the Applicant Please rate the applicant in each of the following categories.






Outstanding

Very Good

Average

Below Average

No comment

Leadership
















Academic Knowledge
















Professionalism
















Clinical Skills
















Interpersonal Skills
















Demonstrates Initiative
















Communication Skills
















Ethics
















Organization Skills
















Volunteerism


















3. Why should this applicant be awarded a HDAF Scholarship? (Please attach a brief letter of recommendation.)

*Recommender – Please return directly to the HDAF office*

RETURN POSTMARKED NO LATER THAN Sept. 15, 2016.



HDA Foundation

3910 South IH-35, Suite 245, Austin, TX 78704
Hispanic Dental Association Foundation

2016-2017 Scholarship Program


DEAN / PROGRAM DIRECTOR VERIFICATION

Section to be completed by Applicant (please type):
I hereby authorize the release of my school’s acceptance information to the Hispanic Dental Association Foundation.

Name of Applicant:


Address:

I have been accepted in a dental, dental hygiene, dental assisting or dental technician program at the following school:

Applicant Signature Date:




Section to be completed by Dean/Program Director:
A. Dean/Program Director’s Name
Phone:
Name of School:
School Address:



Signature Date:
(Requires Verification and Stamp)
Dean / Program Director: Please continue on next page.

Continued from previous page

B. Please provide the following information in order to assist us in evaluating this candidate.
Has the Applicant been accepted or enrolled in your institution for the Fall 2016 term?
 YES  NO

What is the anticipated date of completion for this applicant from this program? Month/Year:



Degree Program
DENTAL:  DDS or  DMD
DENTAL HYGIENE/ASSISTANT/TECHNICIAN:  Baccalaureate  Associate  Certificate


Academic Background
Dental Student Applicant: GPA and Rank on a 4.0 scale
Dental Hygiene/Assistant/Technician Applicant: GPA on a 4.0 scale

Thank you for your cooperation in promoting excellence in the oral health care professions.

Note: Failure to complete this Verification will disqualify the applicant from consideration.

RETURN POSTMARKED NO LATER THAN Sept. 15, 2016.



HDA Foundation

3910 South IH-35, Suite 245, Austin, TX 78704


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