Clone of 2026-27 Rogers and Andrews Scholarship Application

Rogers & Andrews orthodontics Scholarship Application Form

Application Deadline - April 30, 2026
Read and follow the instructions carefully prior to submitting your application. All winners will be notified by telephone.
If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. So, please use proper spelling, capitalization and punctuation.
I. Applicant:

Tell us about yourself
Full Name*

First NameLast Name
Birthdate*

MonthDayYear
Mobile No*
Email *
Where the confirmation will be sent to
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender

MaleFemale
Are you a current patient?

YesNoNo, I am a former patient
II. High School Information
Will you be a High School graduate in Spring of 2027?

YesNo
Current High School
Month and Year of High School Graduation or GED
Most recent cumulative GPA
High School activities, community activities, volunteer work, honors, offices held, please include any part time or full time jobs.
III. ACT Information & SAT Information
Year you took the ACT
Year you took the SAT
ACT composite (overall) score?
SAT score?
SAT & ACT scores are not required for scholarship eligibility. However, providing these scores can increase the likelihood of your selection as compared to other candidates.
IV. References
List the names of your references, limited to two (2) total. Please EMAIL reference letters to Braces3545@gmail.com after submitting your application.
List awards, publications and special recognitions you have received during high school and include year received.
VI. College
What college(s) are you planning to apply to?
VII. Essay
Your essay should be 500 words or less. Your essay must highlight a particular person or event that has influenced your personal life and future aspirations.

The criteria for the scholarship will be based on achievement, leadership, and service throughout the high school years, along with this essay and references.
Essay

0/500
VIII. Applicant's E-Signature
By signing the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
Signature

Clear
DON'T FORGET TO SEND YOUR REFERENCE LETTERS TO BRACES3545@GMAIL.COM.
Your scholarship application will be selected by an impartial board outside of Rogers & Andrews Orthodontics.
Should be Empty:

Rogers & Andrews orthodontics Scholarship Application Form

I. Applicant:

II. High School Information

III. ACT Information & SAT Information

IV. References

VI. College

VII. Essay

VIII. Applicant's E-Signature