Kozak Orthodontics Scholarship Application

Purpose

Dr. Kozak’s interest and commitment to education sparked the idea for this essay contest as a way to encourage literacy among area youth. He appreciates a love of reading, writing and critical thinking. He is very proud to be a part of the SJCA family. Scholarship money will be applied to the winner’s tuition. This scholarship is for 8th grade graduating students who will be registered to attend SJCA for their freshman year. The Kozak Orthodontics Scholarship will award up to two (2) $500 scholarships.

Eligibility

Have a minimum cumulative G.P.A. average of 3.0 (or B).
Be an 8th grade student and registered to attend St. Joseph Catholic Academy as a Freshman in the fall.

Scholarship Requirements

Be registered at SJCA as a FRESHMAN for the 25-26 school year.
Include an essay on “What a smile means to me”. There is no minimum or maximum essay length.
Include a copy of your first semester report card.

Essay

Describe in your own words what a smile means to you. How can a smile make the world a better place? You might include any ideas you have about smiles, such as the effect smiles have on babies, your grandparents, people who don’t speak your language or even animals. Smiles are often referred to as, “the universal language.” Describe, in writing, the impact a smile has on others. How do smiles bridge gaps in generations, language and culture? In other words, how can a smile bring people together? You are free to write about anything that describes what a smile means to you!

All relevant documents must submitted together by March 16, 2025 with the scholarship application to be considered complete.

*Scholarships that are awarded may only be used towards billable tuition. Scholarships may not be used for fees or other charges which include but are not limited to hot lunch, athletics or clubs fees and books. Students that recieve a scholarship and are later awarded a Wisconsin Parental Choice seat will forfeit their scholarship.*

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Email*

example@example.com

Are you currently registered to attend SJCA as a Freshman in Fall 2025?*

YesNo. I understand that if I am not registered by the deadline date, my application will not be considered.

Please tell us something you would like us to know about you.

Cumulative Middle School GPA?

Please upload a copy of your first semester report card from the 2024-25 school year.

Describe in your own words what a smile means to you. How can a smile make the world a better place? You might include any ideas you have about smiles, such as the effect smiles have on babies, your grandparents, people who don’t speak your language or even animals. Smiles are often referred to as, “the universal language.” Describe, in writing, the impact a smile has on others. How do smiles bridge gaps in generations, language and culture? In other words, how can a smile bring people together? You are free to write about anything that describes what a smile means to you!

There is no minimum or maximum essay length. You may upload a document or type in the field below.

Upload Essay Response (Please include your name in the essay)

OR

Essay Response

Selection Process

This scholarship is sponsored by Dr. Bryon Kozak of Kozak Orthodontics, 10320-75th Street, Kenosha, WI 53142. The essays will be reviewed by his team for selection of the scholarship recipients.

I hereby certify that all information are correct and to the best of my knowledge. I will also submit all the documents that will be asked from me for the application purposes.

Student Name & Signature*

Parent/Guardian Name & Signature*

Date

Kozak Orthodontics Scholarship

Student Information

Scholarship Requirements

Essay