Idaho Dental Hygienists’ Foundation
Undergraduate Degree Scholarship Application
Personal Information:
Name
Address
City, State, ZIP
Phone
Birthdate
Degree Sought
Program Location
Certification:
I hereby certify that all information submitted for this scholarship is complete and correct to
the best of my knowledge. I authorize IDHF to obtain additional information concerning
my education as needed to consider me for this scholarship.
I also authorize ________________________________________________________________
(name of enrolled school)
to release information that is pertinent to this application to IDHF. I further authorize
IDHF to include my name when appropriate in the list of winners to be posted in the IDHA
newsletter, on the website, and/or to be publicized in the news media.
_______________________________________________
(signature)
________________________
(date)
Guidelines:
Applicants must be a student member of ADHA at time of application:
 Member #:_________________
Applicants must be enrolled in an accredited undergraduate dental hygiene program.
Scholarships will be awarded based on qualifications determined by the IDHF board.
Please Submit:
Official dental hygiene program transcript.
This completed scholarship application page with signature and date.
The following scholarship application page including:
 Typed list of all community and school involvement: leadership, honors, awards,
organizations, and volunteer work.
 Typed (200 word or less) essay explaining why you are pursuing your degree in
dental hygiene and your plans for the future.
Send scholarship materials postmarked on or before OCTOBER 1 to:
Susanne Jamison
IDHA Executive Director
11141 W Willow Ave.
Nampa, ID 83651
FOR OFFICE USE ONLY
Application ID Number
Date Received
FOR OFFICE USE ONLY
Application ID Number
Idaho Dental Hygienists’ Foundation
Undergraduate Degree Scholarship Application
Section I
Please list all community/school involvement and dates of involvement; include leadership,
honors, awards, organizations, and volunteer work.
Section II
Please explain (in 200 words or less) why you are pursuing a degree in dental hygiene;
include your plans for the future.