Scholarship Application

To begin applying for the Colossians 3:23 Legacy Scholarship, please fill out and submit the form below. On the next page, you’ll upload your submission files. You may come back later to upload files as necessary.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

County

The county of your residence.

Phone Number

(###)

###

####

Parent or Legal Guardian

Parent or Guardian Name

First Name

Last Name

Parent or Guardian Phone Number

(###)

###

####

Parent or Guardian Email Address

High School

Intended College or University

Intended Degree

Honors and Awards

Please list any honors or awards you have received in high school.

Extracurricular Activities

Please list any extracurricular activities, sports, hobbies, or interests outside of school.

Summer Jobs

Have you held any summer jobs? If so, briefly describe.

Volunteer Work

Have you participated in volunteer work? Please describe.

Describe a time when you held a leadership position or position of influence no matter how great or small.

Have you ever served as a mentor? Briefly describe.

What are your career goals?

What’s the wisest advice you've been given by someone in your life?

Letter of Recommendation

In the next step of your application, you will be required to submit a letter of recommendation. For now, please give us the contact information of the person who will write your letter. Please notify the individual recommending that they may be contacted re: the letter.

Name

First Name

Last Name

Relationship to you

Phone Number

(###)

###

####

Watermark Endodontics does not discriminate in admissions, employment, or in any of its educational programs or activities on the basis of race, color, national or ethnic origin, ancestry, age, religion or religious creed, disability or handicap, sex or gender.

2301 12th Street
Meridian, MS 39301

+1 (601) 483 1818
contact@watermarkendo.com

Dr. Mark W. Moore, DMD
Root Canal Specialist