LOUIS C. TALARICO SCHOLARSHIP FUND

GENERAL APPLICATION INFORMATION

The Louis C. Talarico Scholarship Fund is dedicated to Louis C. Talarico, a retired deputy chief of the Lewiston Fire Department. Scholarships may be used at any accredited post- secondary school.

ELIGIBILITY REQUIREMENTS

To receive a scholarship, applicants must meet the following criteria:

• Acceptance into or currently enrolled in an accredited post-secondary school

• A current employee or the dependent child of a current employee of the Lewiston Fire

  Department, where the employee has been employed for a minimum of one year

  APPLICATION PROCEDURE - CHECKLIST

  Complete the following documents and file with the Scholarship Committee postmarked no later than April 30th of the year applying.

  • A completed application form Pages 1-4

  • One letter of reference (teacher, guidance counselor, school administrator, or employer)

  • A current copy of your academic transcript

  • A copy of your current resume

    Review the terms of the sample contract attached at the end of this application. You do not need to sign this copy. A new form will be sent to you for signature when and if you are awarded a scholarship.

    CRITERIA FOR SELECTION

  • ACT or SAT scores, GPA rank in class, and strength of curriculum

  • Financial need including total family income, number of family members in college at

    one time, and extenuating circumstances

  • A fully completed application postmarked no later than April 30 of the year you are

    applying for

    Applications postmarked after April 30th will be returned unopened

Return completed application to the following address: Louis C. Talarico Scholarship Fund
13237 Westmeath Lane
Clarksville, MD 21029

Page 1

LOUIS C. TALARICO SCHOLARSHIP FUND

SCHOLARSHIP APPLICATION

Name ____________________________________________Social Security #_________________________ Street Address____________________________________________________________________________ City ________________________State ___________Zip_____________ Phone _________________
Date of Birth _______________________E-Mail Address ___________________________________

High School______________________________________________ Graduation Date________________________

FUTURE PLANS

Which institution have you decided to attend? __________________________________ What program of study do you plan to pursue? _________________________________ How many years of study are required for this program? __________________________

FINANCIAL INFORMATION

List any scholarships/grants you have received: _________________________________ _______________________________________________________________________

What is the approximate cost per year of the institution you plan to attend?
Tuition ________________Room and Board __________________Other ________________

Page 2

Father
Name ______________________________ Address ____________________________

Mother
Name ____________________________ Address __________________________

LOUIS C. TALARICO SCHOLARSHIP FUND

FAMILY INFORMATION

__________________________ Employer _________________________ Position __________________________

Names of Brothers/Sisters
____________________________________
____________________________________
____________________________________
Please provide any additional information you would like us to have. ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

____________________________
Employer ___________________________
Position ____________________________
Combined Total Annual Income ___________________ Total number of persons dependent on parents ________

Page 3

Age ______ ______ ______

College (if applicable) ________________________ ________________________

________________________

LOUIS C. TALARICO SCHOLARSHIP FUND

TO BE COMPLETED BY GUIDANCE COUNSELOR

Student Name _________________________________ Rank in Class ________ of __________
GPA ________
ACT or SAT Scores _____________

____________________________________________ Signature of Counselor

Page 4

LOUIS C. TALARICO SCHOLARSHIP FUND

TO BE COMPLETED BY EMPLOYER (LFD)

___________________________________is currently and has been an employee of ___________________________________ for a minimum of one year.

Signature ________________________________ Title ____________________________________ Date ____________________________________

Page 5

LOUIS C. TALARICO SCHOLARSHIP FUND

SAMPLE CONTRACT
For Information Only/Do Not Return

In accepting this scholarship, I agree to maintain satisfactory grades in accordance with college standards and to take at least 12 credit hours per semester. I understand that in order to continue to be eligible for this scholarship, I must provide a transcript to the scholarship committee within two (2) weeks of the end of each semester to verify successful completion of a minimum of 12 credit hours and a copy of the tuition bill for the next semester to verify enrollment for that semester.

Scholarship Grant

First Year 2015-2016

Second Year 2016-2017

Third Year 2017-2018

Fourth Year 2018-2019

 $___________________
 $___________________

$___________________
$___________________

Note: Satisfactory academic progress must be made each semester if the student is to receive

subsequent scholarships. Scholarship money will be sent directly to the school.

I agree to the terms and conditions of this contract in accepting this scholarship from the Louis C. Talarico Scholarship Fund.

_____________________________________ Signature of Recipient

_____________________________________ Signature of Parent/Guardian

_____________________________________ Scholarship Committee Member

Date______________________

Date______________________

Date______________________