Latinos for Dental Careers Scholarship Application

Thank you for expressing interest in the CDA Foundation and its scholarship program. We appreciate you applying for our services, which are available to benefit people who want to improve the oral health of all Californians.

Prior to beginning the online application process, please scan the following supporting documents and have them ready to upload as attachments (Word, Excel, PDF, etc.) to this application when prompted to do so later:

Two letters of recommendation - one must be from a faculty member and the other from anyone other than a family member – no exceptions; and
Proof of fulltime enrollment.

During this application process, you will need to answer the questions by typing text, checking boxes/buttons, and where prompted, upload/download documents as attachments to this online application. All requested file uploads and downloads are required to complete your application. Once we have received your application, an automated receipt confirmation will be sent to you at the e-mail address provided below. Good luck!

Submission Criteria

Complete online application, attaching all supporting documents, and submit online.
Approval from CDA Foundation staff is required prior to accepting e-mailed applications. If you are experiencing difficulties submitting the online application, please contact the CDA Foundation staff via e-mail at jolene.murray@cda.org to request an alternative submission method and a Word document of the grant application will be sent to you for completion.

Incomplete applications are ineligible to receive an award.

The open application period for this scholarship program is January 1 through April 30 annually. Applications submitted after April 30 this year will not be considered for this scholarship.

Please direct questions regarding this scholarship application to Santos Cortez, DDS, via telephone at 562.377.1375, or via e-mail at SCortezDDS@aol.com.

Please note that should your mailing address change from the one you have submitted via this application form, it is up to you as the applicant to inform the CDA Foundation in writing of your new updated address so that you will receive future scholarship related correspondences, including the results of this award cycle.

Light Purple Shaded Areas are Required Fields

Please direct questions regarding this scholarship application to Santos Cortez, DDS, via telephone at 562.377.1375, or via e-mail at SCortezDDS@aol.com.

Error: The "Please direct questions regarding this scholarship application to Santos Cortez, DDS, via telephone at 562.377.1375, or via e-mail at SCortezDDS@aol.com." is required.

I. General Information

Error: The "I. General Information" is required.

Date of Application

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Applicant's Name First Name Last Name

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Address Street Street (cont.) City State Zip

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Are you a US Citizen?
Yes No

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If no, please upload documentation of your naturalization or other proof of legal U.S. residency.

Upload File:
Please keep individual attachments under 300k. Please click here for scanning tips.

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Telephone
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E-mail Address
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Your nationality/ethnicity:
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II. College or Program Information

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College/University/School Name
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School Address Street Street (cont.) City State Zip

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You must be currently accepted or enrolled full time in a California dental program and be able to provide proof in order to qualify for this scholarship.

Please upload your proof of acceptance or full time enrollment in your chosen California dental program here.

Upload File:
Please keep individual attachments under 300k. Please click here for scanning tips.

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Year in school
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Anticipated Graduation Date

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What degree, certificate or license are you pursuing?
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What is your overall current GPA?
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You must submit two letters of recommendation, no exceptions.

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" is required.

Letter of Recommendation #1

Please upload your letter here:
Upload File:
Please keep individual attachments under 300k. Please click here for scanning tips.

Error: The "Letter of Recommendation #1" is required.

Letter of Recommendation #2

Please upload your letter here:
Upload File:
Please keep individual attachments under 300k. Please click here for scanning tips.

Error: The "Letter of Recommendation #2" is required.

Financial Information

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What is your annual family household income (include spouse or parents if living with them)?
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What is the total number of family members in your current household?
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Annual tuition fees for the current school year
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Annual academic books and supplies costs
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Annual family household living expenses
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Will you work during the school year?
Yes No

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If yes, how many hours/week
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Demonstrate your estimated financial need by describing your financial background and current financial situation.
Maximum 1,500 characters. Characters used: 0.

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IV. Personal Statements

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a) Describe extracurricular activities that you've been involved with (i.e. volunteer, organizations, church, community, etc.):
Maximum 1,000 characters. Characters used: 0.

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b) Describe how your heritage has contributed to who you are today:
Maximum 2,000 characters. Characters used: 0.

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c) Describe your career goals and why you are seeking a scholarship:
Maximum 2,200 characters. Characters used: 0.

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V. Certification

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I acknowledge that the decisions of the Latinos for Dental Careers committee and the CDA Foundation are final and that this is a competitive selection process. I certify that the information provided is complete and accurate to the best of my knowledge. I understand that this application may be denied or withdrawn if it is incomplete and/or if any information reported is found to be intentionally misleading, inaccurate or fraudulent.

I give my permission for the Latinos for Dental Careers and the CDA Foundation representatives to contact my references and school officials for additional information or character reference. If selected to receive a scholarship, I authorize the Latinos for Dental Careers and CDA Foundation to use my name, personal story and/or photo for the purpose of community relations.

Error: The "I acknowledge that the decisions of the Latinos for Dental Careers committee and the CDA Foundation are final and that this is a competitive selection process. I certify that the information provided is complete and accurate to the best of my knowledge. I understand that this application may be denied or withdrawn if it is incomplete and/or if any information reported is found to be intentionally misleading, inaccurate or fraudulent.

I give my permission for the Latinos for Dental Careers and the CDA Foundation representatives to contact my references and school officials for additional information or character reference. If selected to receive a scholarship, I authorize the Latinos for Dental Careers and CDA Foundation to use my name, personal story and/or photo for the purpose of community relations." is required.

Electronic Signature (Required)

Error: The "Electronic Signature (Required)" is required.

Please check the electronic signature button, type in your first and last name in the space provided, and click the button on this page labeled "Submit" to certify that all statements made in this application and its attachments are complete and accurate to the best of your knowledge, and to authorize the Latinos for Dental Careers and CDA Foundation to verify the information provided in this application.

Error: The "Please check the electronic signature button, type in your first and last name in the space provided, and click the button on this page labeled "Submit" to certify that all statements made in this application and its attachments are complete and accurate to the best of your knowledge, and to authorize the Latinos for Dental Careers and CDA Foundation to verify the information provided in this application." is required.

Electronic signature (type full name):

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By submitting your application, you certify that all statements made in this application and its attachments are complete and accurate, and you understand that falsification will disqualify your application. Applicant understands and agrees that by your signing this application, you give permission to the CDA Foundation and Latinos for Dental Careers (LDC) organization representatives to contact your references and school officials for additional information or character reference. If selected to receive a scholarship, you authorize the CDA Foundation and LDC organization to use your name, personal story and/or photo for the purpose of community relations.

Error: The "By submitting your application, you certify that all statements made in this application and its attachments are complete and accurate, and you understand that falsification will disqualify your application. Applicant understands and agrees that by your signing this application, you give permission to the CDA Foundation and Latinos for Dental Careers (LDC) organization representatives to contact your references and school officials for additional information or character reference. If selected to receive a scholarship, you authorize the CDA Foundation and LDC organization to use your name, personal story and/or photo for the purpose of community relations." is required.
How did you learn about the LDC Scholarship Program?
Error: The "How did you learn about the LDC Scholarship Program?" is required.

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