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 *
EDUCATION 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 *
FINANCIAL INFORMATION
Contributions
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.)
 *
ACADEMIC CRITERIA
20) Current GPA *
21) Healthcare, Public Safety/Service-Related Coursework
 *
22) Noteworthy Academic Accomplishments
 *
23) Noteworthy Academic Challenges
 *
COMMUNITY SERVICE
24) Please list community organizations you have participated in during the past 24 months
 *
AWARDS/HONORS
25) Please list the name(s) of award(s)/honor(s) you earned and dates(s) received
 *
ABOUT YOU
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.
VERIFICATION
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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