2023 HDAF Scholarship Application

Application Status
Recommendation Form ReceivedDean Form ReceivedFinancial Form Received
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 the field of dentistry. These scholarships will be awarded to support meritorious work by Hispanic/Latino students who seek to advance their scientific and applied clinical knowledge as they enter into the oral health profession. Scholarship amounts vary depending on the Funder of Scholarship. Please refer to each scholarship description for details.

What is the intent of the scholarship?
The intent of the 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, and dental hygiene 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, or dental hygiene programs. Students must be a current student member of the Hispanic Dental Association.

How does one apply?
The attached application form must be submitted online to the Hispanic Dental Association Foundation. The application must be received by the Foundation no later March 24, 2024. The application must be 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
- Create a bridge to drive Hispanic representation for future generations
What is the timing of the scholarship program?

For the 2024 academic year, the application must be submitted online no later than March 24, 2024. The award decisions will be final and communicated to all applicants by April 25, 2024.
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 a CODA accredited dental residency, dental program, or dental hygiene program in the U.S. or Puerto Rico.
- Be a current HDA (Hispanic Dental Association) member or a Hispanic Student Dental Association (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 be in good academic standing at your school if your dental program does not provide a GPA.
- Show evidence of commitment and dedication to improve the oral health of the Hispanic community.
- ShapeNot have been a previous recipient/awardee of an HDAF Scholarship in the category of your application. (Example: dental student winners cannot apply in a following year as a dental student. However, can apply as a resident if appliable.)
Please read all materials carefully. It is YOUR responsibility to ensure that ALL the necessary materials are received at the HDA Foundation office by the deadline.
Scholarship Application Deadline
- You must submit your completed application to the Hispanic Dental Association Foundation (HDAF) online no later than March 24, 2024.
- The Verification form must be sent directly from the school to the HDAF through the online process no later than March 24, 2024. (Remember you are to complete the top portion of the Verification Form.)
- One (1) Recommendation must be submitted directly from the Recommender through the online process no later than March 24, 2024. (Remember you are to complete the top portion of the Recommendation form.)
- The award decisions will be communicated to all applicants by April 25, 2024.
- As part of the application you are required to submit a 2-3 minute video explaining once your education is completed what are your plans to the help the underserved communities have access to oral healthcare and how do you see yourself being an advocate to encourage other Hispanics to pursue careers in oral healthcare? Parts of or your complete essay/video may be used in HDA/HDAF/Sponsor publications. Submission of this application gives your approval for said use.
- If you are a recipient of any scholarship award, except the Crest+Oral B Bridges awards your presence is required at the HSDA Regional Conference at New York University College of Dentistry on Thursday June 20, 2024. You will be given up to $500 to help cover travel expenses.
- If you are a recipient of a Crest+Oral B Bridges award you must attend the Virtual Awards Ceremony on May 15, 2024.
FAILURE TO SUBMIT A FULLY COMPLETE APPLICATION WITH ALL THE ITEMS LISTED ABOVE BY THE APPROPRIATE DEADLINE DATE WILL RESULT IN REJECTION OF YOUR ENTIRE APPLICATION.

PLEASE READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING APPLICATION. ALL APPLICATIONS MUST BE COMPLETED IN ENGLISH.
APPLICANT’S NAME*

First NameLast Name
Email Address (personal)*
example@example.com
Select your School's State:*
Select the state where you will be attending school.
CREST+ORAL-B (Dental Students, Dental Hygiene Students)DELTA DENTAL OF ILLINOIS FOUNDATION (Dental Students, Dental Hygiene Students) IL Schools OnlyCOLGATE (Dental Residency or Specialty Students)COLGATE (Dental Students, Dental Hygiene Students)A-DEC (Dental Students - 3rd, 4th year)COLGATE LATIN LEADERSHIP NETWORK (Dental Students) NY, NJ, KS Schools Only

SCHOLARSHIP APPLICATION

PLEASE READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING APPLICATION. ALL APPLICATIONS MUST BE TYPED IN ENGLISH.
A. General Information
Applicant Full Name*

First NameLast Name
Mailing Address While in School*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Permanent Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone #*
Format: (000) 000-0000.
Email (school)*
example@example.com
B. Program
DENTAL: DDSDENTAL: DMDDENTAL HYGIENEDENTAL GRADUATE PROGRAM
School (note year in school)*
Specialty Program, if applies, if not please type N/A*
Dean or Program Director Name:*

First NameLast Name
Dean or Program Director Email:*
example@example.com
Dean or Program Director Telephone*
Format: (000) 000-0000.
C. Education (Dental Applicants – list main College and Dental Schools attended)
From:*

MonthDayYear
Date
To:*

MonthDayYear
Date
Degree Earned:*
School:*
From:

MonthDayYear
Date
To:

MonthDayYear
Date
Degree Earned:
School:
From:

MonthDayYear
Date
To:

MonthDayYear
Date
Degree Earned:
School:

D. Community Service

List student, professional association, community-based research and/or volunteer experiences (with dates of participation) that include up to 10 activities, with preference given to Hispanic community outreach and Hispanic oral health related activities:
Date/Name of Organization/ Brief Description of Activity*
E. Leadership Positions

List any HSDA or other Leadership positions (with dates of participation) you have held while in or leading up to your dental program, or any other examples or your personal leadership experiences List up to 5 total:
Date/Name of Organization/Position(s) Held*
F. Honors

List any honors and/or awards received in any capacity eg: scholastic achievements, scholarships, community service, leadership, and extracurricular activities (with dates of participation). List up to 5 total:
Date/Name of Organization/Position(s) Held*
G. Video Essay Submission

Please include a link in the space provided of a 2-3 minute video using YouTube of yourself outlining once your education is completed what are your plans to help the underserved communities increase their access to better oral healthcare and how do you see yourself being an advocate to encourage other Hispanics to persue careers in oral healthcare? Your video must be a maximum of 3 minutes. Please use a plain background with no loud music or visual effects. Start the video with your name, school and program year. Must be a YouTube video link
Link to YouTube Video:*
Video Format: must be YouTube video!
H. AUTHORIZATION

I HEREBY AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED WITHIN THIS APPLICATION. I UNDERSTAND ANY MISREPRESENTATION OR OMISSION OF FACTS ARE CAUSE FOR DISQUALIFICATION.
I. Disclaimer

CANDIDATES MUST DISCLOSE ANY POTENTIAL CONFLICTS OR RELATIONSHIPS WITH SCHOLARSHIP CONTRIBUTORS, LEADERSHIP OF THE H.D.A OR H.D.A. FOUNDATION.
Name:

First NameLast Name
Relationship:
Signing this application gives the HDA Foundation and corporate sponsors the right to use photographs and videos of the applicant.
Signature*

Clear
Date*

MonthDayYear
Date

2024 SCHOLARSHIP APPLICATION RECOMMENDATION

Applicant must provide one Recommendation contact from a clinical or didactic faculty member or a school administrator. Recommendation Checklist must be completed online. Recommender will receive an email with information on how to complete the form. Please tell your Recommender to look for it. It may end up in spam. Section to be completed by Applicant (please type):
Name of Applicant
Address:
Applicant Signature*

Clear
Date*

MonthDayYear
Date
Dental School FacultyOther
Recommender Name*
Company or School*
Recommender Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Recommender Phone*
Format: (000) 000-0000.
Recommender Email*
example@example.com
YES
Please be sure to notify your Recommender that they will receive the recommendation form by email so they can expect it and complete it in a timely manner.
NOTE: Failure to provide one recommendation will disqualify the application.
Need help? Watch our Help Video.

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.
Applicant Name*

First NameLast Name
Applicant Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I have been accepted in a dental or dental hygiene program at the following school:*
Dean/Program Director’s Email *
example@example.com
YES
Please be sure to notify your Dean / Program Director that they will receive the verification form by email so they can expect it and complete it in a timely manner.
Applicant Signature*

Clear
Date*

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

FINANCIAL AID VERIFICATION
Applicant must provide contact info of the Financial Aid Officer so they can complete the separate Financial Aid Verification Form.

Section to be completed by Applicant: (please type)

I hereby authorize the release of my financial aid information to the Hispanic Dental Association Foundation.
Applicant Name:*

First NameLast Name
Applicant Signature*

Clear
Date*

MonthDayYear
Date
I have been approved to receive financial aid at the following school:
Name of School:*
Name Financial Aid Officer:*

First NameLast Name
Financial Aid Officer Email:*
example@example.com
Financial Aid Officer Phone:*
Please enter a valid phone number.Format: (000) 000-0000.
YES
Section to be completed by Financial Aid Officer: (please type)
This section hidden from Applicant. To be filled out by Financial Aid Officer only.
Note: Failure to complete the Financial Aid Verification will disqualify the applicant from consideration.
RETURN ONLINE NO LATER THAN March 24, 2024
Questions: 317-714-0037 Email: hdafoundationscholarships@gmail.com
Should be Empty:

SCHOLARSHIP APPLICATION INSTRUCTIONS

Eligibility Requirements

Scholarship Application Deadline

SCHOLARSHIP APPLICATION

2024 SCHOLARSHIP APPLICATION RECOMMENDATION

DEAN / PROGRAM DIRECTOR VERIFICATION

FINANCIAL AID VERIFICATION