ACADEMIC YEAR 2015-16
Scholarship Procedures
UNC SCHOOL OF DENTISTRY
and
THE DENTAL FOUNDATION OF NORTH CAROLINA, INC.
The Dental Foundation of North Carolina (DFNC) awards scholarships to UNC School of Dentistry students
each year. APPLICATIONS MUST BE SUBMITTED NO LATER THAN 5 PM ON FRIDAY, AUGUST 28TH,
2015. Applicants must be eligible for financial aid through the University’s Office of Scholarships and Student
Aid.
Scholarships are awarded on the basis of financial need, academic performance, potential for careers in
dentistry, and other criteria for selection. The selections are made by a committee of School of Dentistry
administrators and DFNC board members and are based on information provided on the application form and
by the UNC financial aid office. Students are not interviewed.
Winners will receive their scholarship funds in the fall. Unfortunately, because the number of applicants greatly
exceeds the number of scholarships available, not all applicants will be awarded scholarships.
Students do not apply for specific awards; a single application is sufficient for all scholarships. However,
students in categories for which preference may be given should make sure such information is apparent on
the application.
Questions about scholarships can be answered by Nicole Quallen, DFNC Assistant Director of Development
at quallen@unc.edu.
The Dental Foundation of North Carolina exists for the sole purpose of benefiting the students, faculty, and
programs of the UNC School of Dentistry. The DFNC raises private funds to support student scholarships and
awards, faculty professorships, research fellowships, teaching awards, and building construction and
renovation. With funds raised through the generosity of private citizens and friends of the School, the
Foundation awards student scholarships and fellowships each year.
Completed applications must be submitted (by hand, mail, or email) to the Dental Foundation office NO
LATER THAN 5 PM ON FRIDAY, AUGUST 28th, 2015.
Mailing address:
Dental Foundation of North Carolina, Inc.
Attn: Nicole Quallen, Assistant Director of Development
Campus Box #7450
Chapel Hill, NC 27599-7450
Physical address: 1090 Old Dental Building
Phone:
(919) 537-3257
Email:
quallen@unc.edu
ACADEMIC YEAR 2015-16
Scholarship Application
UNC SCHOOL OF DENTISTRY
and
THE DENTAL FOUNDATION OF NORTH CAROLINA, INC.
DUE: FRIDAY, AUGUST 28, 2015
_____________________________________________________________________________________________________
Last Name
First Name
Middle Name
____________________________________
PID #
_____________________________________________________________________________________________________
Local Street Address
_____________________________________________________________________________________________________
Local City, State, Zip Code
Local Telephone Number
Email Address
_____________________________________________________________________________________________________
Home Street Address
_____________________________________________________________________________________________________
Home City, State, Zip Code
Planned graduation date: _________________________________________________________
Class Standing for 2015-16 Year: (Please Circle) 1st year
2nd year
3rd year
4th year
Are you a legal resident of North Carolina for tuition purposes? ________________
If yes, which county in North Carolina? _______________________________________
Birth place: _______________________________________________________________
High school you attended: _______________________________________________________
County of high school attended, if in North Carolina:___________________________
Universities/Colleges Attended:
_____________________________________________________________________________________________________
Dates Attended:
Degree Earned:
__________________________________________________________________________________________________
Dates Attended:
Degree Earned:
_____________________________________________________________________________________________________
From which university or college did you graduate?
______________________________________________________________________________
Date of graduation from above institution:
________________________________________________________________________________________
All additional coursework and grades earned (i.e., courses taken at other universities/colleges or toward Master’s or Ph.D. in
another field):__________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
ACADEMIC YEAR 2015-16
Remember, you must be eligible for financial aid through the Office of Scholarships and Student Aid. Eligibility is
based on the FAFSA. You can complete the FAFSA online at http://www.fafsa.ed.gov. The FAFSA must be
completed by August 17, 2015 to be processed in time for these awards.
Optional
Please indicate if you are a member of one of the following minority groups:
1. ____ American Indian or Alaskan Native. Persons having origin in any of the original peoples of North America,
and who maintain cultural identification through tribal affiliation or community recognition.
2. ____ Asian or Pacific Islander.
3. ____ African-American.
4. ____ Hispanic/Latino.
5. ____ Other, please identify: ___________________________________________________________________
NON-DISCRIMINATION POLICY
With respect to equal employment and educational opportunity, it is the policy of University of North Carolina at
Chapel Hill and the School of Dentistry not to discriminate on the basis of age, sex, race, color, national origin,
religion, disability, or sexual orientation.
Please answer the following questions. All answers must be typed and single-spaced. An electronic version of the document can be
accessed at https://www.dentistry.unc.edu/foundation/scholarships.cfm. You may type directly on this page or turn in an alternate page.
Applications may be dropped off at 1090 Old Dental; mailed to the DFNC Office, CB # 7450, UNC School of Dentistry, Chapel Hill, NC
27599-7450; or emailed to Nicole Quallen at quallen@unc.edu. If you have any questions, please call the DFNC at 919-537-3257.
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PLEASE LIMIT YOUR TOTAL RESPONSE TO ONE PAGE.
DO NOT attach CVs, transcripts, etc. to application as they will not be presented to the selection committee.
NAME SHOULD APPEAR ON ALL PAGES (application cover sheet and response sheet).
1. Please give information that you believe is pertinent to your need for financial assistance. You should include your expected sources of
financial support and expenses.
2. Please describe your experiences in dentistry.
3. Please provide a brief statement of your educational and career objectives.