Form

Excellence in Commitment Award Application

Our Mission

This award recognizes students who demonstrate strong character, leadership, academic effort, or community involvement.

Who Can Apply

- Ages 13–19
- Demonstratedleadership, service, and/or academic effort
- Good dental hygiene standing
- Willing to commit to orthodontic treatment

Please read the entire application carefully before beginning. This is a comprehensive application, and all required materials must be prepared in advance. Your progress will not be saved, and the application must be completed and submitted in one session.

Applicant Information

First Name

Last Name

Date Of Birth

Current School

Current GPA

How did you hear about the program?

Guardian Information

Please provide the following contact information.

First Name

Last Name

Date Of Birth

Address

City

Zip Code

Phone

Written Statements

Please upload your essays in one document answering the following three questions:

1. Describe the orthodontic problem you have and explain how correcting it would affect your daily life at school, at home, and with others. (250 word minimum)

2. Orthodontic treatment is a commitment that takes time and effort. How would you take care of your braces or aligners and keep your appointments? (250 words minimum)

3. Describe a time you took initiative or demonstrated leadership in your school, family, or community. What problem or situation did you recognize, what actions did you personally take, and what was the result? Reflect on what this experience reveals about your character and values. (250 words minimum)

PDF or DOC format accepted.

Essays Upload

Upload or drag files here

Letter of Recommendations

Please upload letters from teachers, counselors, or school administrators who can speak to your academic effort, character, or community involvement.

Guidelines:

PDF format preferred
Letters may be written within the last 12 months

Upload Letter of Recommendation #1

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Upload Letter of Recommendation #2

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Most Recent Transcript

Upload your most recent school transcript or report card. An official transcript is preferred but not required.

Acceptable documents include:

Recent report card
Official or unofficial transcript
Screenshot or PDF from the school portal

PDF, PNG, JPG files accepted.

Most Recent Transcript

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Intraoral Photos

To properly evaluate your application, we require clear orthodontic screening photos. These images allow Dr. Luke to assess alignment, bite relationships, and overall treatment complexity.

What You’ll Need