IOH Scholarships - Program Director Verification - 2018-2019)

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ADHA Institute for Oral Health Scholarship

Program Director Verification Form


A student from your academic institution has applied for an ADHA Institute for Oral Health scholarship. In order to consider the student’s application, it is necessary to verify their enrollment status, grade point average, and expected graduation date. Verification forms must be submitted on or before February 1, 2018 for the student to be considered.

In addition, we strongly recommend that you save a copy of this form for your records and for the applicant’s personal file. 

Note: failure to complete this form in its entirety and submit it by the application deadline date will jeopardize the applicant’s consideration for the scholarship.

Complete this section to the best of your abilitwith necessary consultation with your institution’s Registrar or Office of Student Affairs. 

If the applicant is a graduate student, this form may be completed by general program director (e.g. not dental hygiene.)   If a specific program director does not exist, please contact ADHA's Institute staff for further direction. 

If you have any questions, please feel free to call ADHA's Institute at 312/440-8944 or email Joan Brazas, IOH Development Manager, at