Fillable 9452DeltaDental FORM Delta Dental Scholarship Application

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9452DeltaDental FORM Delta Dental Scholarship Application

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Delta Dental Plan of Wyoming
DENTAL HYGIENE SCHOLARSHIP
Criteria for Selection:
Wyoming Resident
Entering the 3rd term of program
(Anticipated graduation the following Spring)
Financial Need
Grade Point Average
Evaluation of a typed essay
Not receiving numerous outside awards
Application Requirements:
Submit an application and typed essay by April 1
Guidelines for Scholarship Distribution:
1. The Dental Hygiene Program Scholarship Chair will distribute the
applications.
2. Delta Dental will select a recipient and notify the Dental Hygiene Program
by May 15.
3. Delta will present the prior year Scholarship winner with a Plaque and
announce the recipient for the following year at the Award/Recognition
Ceremony in May.
4. After the Dental Hygiene Program has notified Delta that the Recipient
has returned for the Fall semester and is in good standing, a check will be
distributed through the Dental Hygiene Scholarship Chair for use during the
final year of the Dental Hygiene Program.
Produced by LCCC Public Relations PRS 9452 4/12
DENTAL HYGIENE SCHOLARSHIP
DELTA DENTAL PLAN OF WYOMING
Name
Address
Street
City, State, ZIP
Phone Number
Number of years in Wyoming Cumulative GPA in
Dental Hygiene course work
Advisor’s Signature
Please type an essay of at least 300 words explaining your goals in the dental hygiene eld.
In order to help Delta Dental determine your nancial need, please answer the following questions:
1. Are you nancing your own college?
Yes No
2. Gross income as reported on last years income tax form: Self $_____________
Parents if applicable $_____________
3. If parent supported, how many siblings? _______
How many are attending a post-secondary school? _______
4. If self supported, number of dependents reported on last years income tax form? _______
How many are attending a post-secondary institution? _______
5. Scholarships, grants, and nancial aid received this year (please specify approximate dollar amounts):
_______________________________________________________________________________________________
6. Do you expect to receive a similar nancial aid package next year?
Yes No
7. Please list any other nancial obligations:
_______________________________________________________________________________________________
By checking this box, I hereby certify that the information provided is accurate to the best of my
knowledge. In addition, I authorize the Scholarship and Financial Aid Office at LCCC to release
any financial aid information that I or my parents have provided to LCCC as application for
financial aid or scholarships.
_____________________
Date
Submission Instructions
Submit application before April 1.
Please note the pop-up window that appears after you click
Submit.
1. e window will ask you to select your email client.
2. If you use Microsoft Outlook Express, Microsoft
Outlook, Eudora or Mail, click “OK” in the pop-up
window. e form will be emailed to us.
3. If you use any other client, such as Yahoo or Hotmail,
choose “Internet Email,” then click “OK.”
• ecomputerwillsavetheformtoyourharddrive.
• Openyouremailaccount.
• Attachtheformtoamessageandemailitto
FinancialAid@lccc.wy.edu.
4. PleasecontactFinancialAidat307.778.1156tomake
suretheformwasreceivedsuccessfully.
or
andmailto: LaramieCountyCommunityCollege
Scholarship&FinancialAidOce
1400E.CollegeDrive
Cheyenne,WY82007
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9452DeltaDental FORM Delta Dental Scholarship Application

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Completed 15 February 2020

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