Dr. Diters Legacy Scholarship Application

In 1989, the community gathered to celebrate Dr. Edward Nelson Diters on the occasion of his retirement, after over 40 years of dedicated service as Canton’s family doctor. In his honor, the community generously donated the initial funding to create the Dr. Diters Legacy Scholarship.

Today, Canton Community Health Fund continues to honor the work of Dr. Diters by providing Scholarships to graduating Canton High School students pursuing a future in healthcare or public safety through further education, training or certification.

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1) I am a current Canton High School Senior *
2) Name *
3) Address *
4) Phone # *
5) Email *
FAMILY INFORMATION (if you qualify as a dependent)
6) Name(s) of Parent/Guardian *
7) Parent/Guardian Contact Information *
8) Vocation/Career Plans *
9) Certification/Major/Concentration/Field of Study
10) Name(s) of College/Vocational School/Certification Program Accepted
11) Name of School/Program Attending *
12) Personal Savings *
13) Part/Full-Time Employer/Position
14) Annual Income from Employment
15) Scholarships (already awarded)
16) Other Contributions (including from parents/family)
17) Total Curent Funding Available $ *
18) FAFSA Filed? *
19) Estimated Expenses (tuition, room/board, fees, books, etc.)
20) Current GPA *
21) Healthcare, Public Safety/Service-Related Coursework
22) Noteworthy Academic Accomplishments
23) Noteworthy Academic Challenges
24) Please list community organizations you have participated in during the past 24 months
25) Please list the name(s) of award(s)/honor(s) you earned and dates(s) received
26) Why are you a strong candidate for the Dr. Diters Scholarship?
27) Use this space to describe any personal or extenuating circumstances that you feel warrant consideration.
By submitting this application for a Dr. Diters Scholarship, you certify that all information provided herein is true and accurate.

Please enter your initials below to submit this application:

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