Southern Heights Dentral Group Scholarship Form
Deadline: March 16, 2026 3:00 pm

First name

Last name

Address

Phone

Overall High School GPA

Fall 2026 College or University

Intended Area(s) of Study

Describe your career goals in the field of dentistry.

Discuss your personal qualities, experiences and relationships that influenced you toward the field of dentistry.

Explain your academic, volunteer and/or work history

Provide a paragraph on why you would be a good choice for this scholarship

What would this scholarship mean to you?

File upload

APPLICANT SIGNATURE Signing here certifies that the information provided is true and accurate to the best of my knowledge.

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Date

Month

Day

Year

PARENT OR GUARDIAN SIGNATURE Signing here certifies that the information provided is true and accurate to the best of my knowledge.

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