Glick Dental Associates

Name of Participating High School:       Solon (Only selected schools are eligible)

Name:                

Street Address:  

City:                    

State:                   OH      Zip code: 

Phone:                    E-Mail:

_________________________________________________________________________

Male      Female                

                                  Birth Date:       

Class Rank:              out of            GPA:       

______________________________________________________

List school organizations and activities in which you have participated and note offices which you have held:

What outside school activities do you participate in such as church youth group, scouts, volunteer work, etc. and note any office held:  

List employment: (summer or other jobs that may bear on this application)

Where do you plan you continue your education after high school?

Have you been formally accepted at the institution listed above?

Yes                No

In what field or major do you plan to study after high school?

Please submit an original essay of no more than 3 or 4 paragraphs that outlines your thoughts as to why the reader should consider you for this scholarship.

If you find it more convenient you may write the essay in a text editor such as Microsoft Word™  and cut-and-paste the text into the space above.