Dr. Alfred J Loser Memorial Scholarship Fund APPLICATION FOR FINANCIAL ASSISTANCE. Date: Application Due Date: May 1, 2016

Transcription

1 Dr. Alfred J Loser Memorial Scholarship Fund APPLICATION FOR FINANCIAL ASSISTANCE Date: Application Due Date: May 1, 2016 Applicant's Name: Academic School Year: The Dr. Alfred J Loser Memorial Scholarship Board of Directors invites prospective college students to apply for financial assistance for educational purposes. Prior to his death in November, 1977, Dr. Alfred J. Loser, a medical doctor in South Lorain for more than 50 years, established in his will a trust fund to be used exclusively for awarding scholarships to the GRADUATES OF THE LORAIN HIGH SCHOOL. One specific stipulation was that the scholarship be give to "needy and worthy students" without regard to race, creed or color. Consideration will be given to the following: (1) Students who are graduates from Lorain High School during this academic school year: (2) Students from families in need of financial aid; and (3) Students who rank in the top one-third of their class academically; however, educators are encouraged to recommend exceptional students who are below this level due to extenuating circumstances. (4) College students who ve graduated from Lorain High, Admiral King, Southview or Lorain Catholic. Referral Source (How did you find out about this scholarship?) 1. Guidance Counselor Name 2. Teacher Name 3. Other Name/Organization Revised 02/11/2016

2 Applicant Name: Address: City State Zip Telephone No.: Alt. Phone No.: Present Age: Date of Birth: Place of Birth: Employment Experience: Employer Duties From / To Family Data: Father's name Address: City State Zip Employer: Occupation: ************************************************************************ Mother's Name: Address: City State Zip Employer: Annual Wages (Father): Annual Wages (Mother): Other income: Annual Wages of Applicant if Employed: Total Family Income: Occupation: Number of Family Member's presently residing in the home: Ages of Siblings:

3 Ethnic Group and Sex Classification: In order to comply with the U.S. Government reporting requirements, ethnic background, marital status, and sex data are necessary. Please mark the appropriate category. Female Male White (not of Hispanic origin) African American (not of Hispanic origin) Native American (American Indian) Asian or Pacific Islander Hispanic Marital Status: Please mark the appropriate category below. Single Married Separated Divorced Widowed EDUCATIONAL EXPERIENCE Educational Experiences: List previous schools and dates attended. School Location Dates Attended Elementary Junior High High School College Class Rank: Academically, do you rank in the top one-third of your class: Yes No You rank number in a class of. (If you know it) Academic Honors and Awards: Please list on the lines below and attach all relevant information regarding the Academic Honors and Awards you have received:

4 Academic Achievement Please provide evidence of your academic achievement by citing special courses and credit or grades received. Also attach copies of your most recent updated Secondary School Record Form, High School and/or college transcripts and letters of recommendation from teachers, counselors, and/or college instructors.

5 GOAL STATEMENTS AND GENERAL INFORMATION List the colleges/universities to which you have applied for admission: List the college/universities you are attending/or have attended. As a prospective candidate for a Dr. Alfred J Loser Memorial Scholarship, please mark the appropriate status of your application below: First time high school applicant First time college applicant Please specify the types of Financial Aid that you will be receiving by checking the appropriate category/categories below: Pell Grant OCOG Strafford Loans Perkins Plus Loans Scholarships College/University Grants Work/Study Program Grants Student Loans Other NOTE: If you have marked any of the above, please describe the type and dollar amount of assistance that you will be receiving. Type: Amount:

6 *** Answer ONE the following questions to the best of your ability. Please type your answers neatly and attach them to this application. (There is a 500 word limit) 1) State your present educational goal(s) and discuss how this/these goal(s) may help you achieve your long range goal(s). 2) Explain how you can help to improve the quality of life for all citizens in the City of Lorain though your career/professional choice. 3) Given the large number of applicants who are applying for this grant, discuss why you believe that the Loser Scholarship Board should award you a scholarship. NOTE: We also award an Irving Leibowitz Award and/or the P.C. Campana Award for exceptional achievement, but no additional application is required. If you are a student candidate and selected for the Irving Leibowitz Award or the P.C. Campana Award, you may be notified in the near future regarding the date and site for your personal interview.

7 APPLICANT'S STATEMENT OF FINANCIAL NEED What will be your total costs for this college school year: How much money will you have available for this school year: (Include amount to be received from scholarships, grants, loans etc) What is the total amount of assistance that will be needed: NOTE: THIS DOCUMENT MUST BE NOTARIZED BY A CERTIFIED NOTARY PUBLIC OR IT MAY NOT BE REVIEWED OR GIVEN FULL CONSIDERATION BY THE DR. ALFRED J LOSER SCHOLARSHIP FUND BOARD OF TRUSTEES. I, the parent/legal guardian of, hereby authorize the school to release my child's transcripts of grades and test scores to the Dr Alfred J Loser Memorial Scholarship Fund Board. I, the undersigned, after first being duly sworn, depose and say that the above stated facts regarding our financial status are accurate and try as written. I understand that any misrepresentation may be cause for denial or cancellation of an award from the Dr. Alfred J Loser Memorial Scholarship. Signature of Parent/Guardian Signature of Student over 18 Signature and valid stamp of Notary Public OR In place of the APPLICANT S STATEMENT OF FINANCIAL NEED, a copy of the FASFA Student Aid Report (SAR) could be attached. If the (SAR) is attached the Notary Public Signature is not required for the Applicant s statement of financial need.

8 PRESS RELEASE The Dr. Alfred J. Loser Memorial Scholarship Fund is celebrating its 37th Anniversary of Awarding College Scholarships to graduates of high schools in Lorain. Over the last 37 years the Board of the Dr. Alfred J. Loser Memorial Scholarship Fund have awarded over 1,300 scholarships, totaling more than $850,000 to Lorain students. A historical overview of the Dr. Alfred J. Loser Memorial Scholarship Fund Prior to his death in November, 1977, Dr. Alfred J. Loser, a medical doctor in South Lorain for more than 50 years, established in his will a trust fund to be used exclusively for awarding scholarships to the graduates of the four high schools in Lorain - Southview, Lorain, Admiral King and Lorain Catholic. One specific stipulation was that the scholarship be give to "needy and worthy students" without regard to race, creed or color. Dr. Loser authorized Attorney E.G. "Leo" Koury to be the executor of his estate. For the purpose of carrying out the objectives of his will, Dr. Loser directed Mr. Koury to assemble a board of directors of five persons of character who were dedicated to the improvement of the community and the welfare of its citizens. The Dr. Alfred J. Loser Memorial Scholarship Fund Board of Directors was organized in January, 1978, eleven months after the death of Dr. Loser. The Board Members were as follows: Attorney Koury, Mr. Irving Leibowitz, editor of the Lorain Journal; Dr. Fleming Mosely, principal of Lincoln School; Father Bruce Ward, pastor of Sacred Heart Chapel; and Miss Haydee Rivera, a legal secretary. The major duties of the Board as dictated by the will were: (1) Managing and reviewing the investments of the scholarship fund and investing the assets properly; (2) Holding scheduled meetings for the purpose of choosing and interviewing prospective scholarship recipients; and (3) Awarding scholarships to worthy and ambitious students needing such funds to further their education. The Board presented their first group of 27 students with more than $14,000 in scholarship awards in After 37 years, the Board has awarded almost 1,300 scholarships totaling, over $850, When Mr. Leibowitz died in April, 1979, the remaining Board Members created the Leibowitz Memorial Award which is now presented annually to the most outstanding Loser Scholarship recipient after an intensive interview. Dr. Mosely is the only remaining member of the original Board of Directors. Miss Rivera resigned in 1979 to get married, and Father Ward resigned in 1980 and relocated to California. Attorney Leo Koury became Chairman Emeritus Board Member in The present Board Members, in addition to Dr. Mosely, are Mr. Paul Biber, a retired Admiral King teacher and former Lorain School Board Member; Miss Catherine Catanzarite, a retired Court Administrator, Mr. Lee Koury, Mr. Brian Morgan and Mrs. Lori Campana.

9 IMPORTANT INSTRUCTIONS FOR PAYMENT OF YOUR SCHOLARSHIP YOU, the student recipient are personally responsible for submitting all documentation and forms to the office of the Dr. Alfred Loser Memorial Scholarship Board so that your scholarship funds will be sent directly to your chosen college/university. Hence, you are to follow the procedure cited below: IMMEDIATELY REQUEST WRITTEN VERIFICATION (e.g., a tuition bill, a class schedule, or an official letter) from the college/university, which you have chosen, which states that you will be attending their institution this academic school year. This written verification must include the name of the college/university, their mailing address, and your name and student identification number. (The written verification to be submitted can be an original or a photocopy.) This written verification that you are attending a college or university must be mailed to: The Dr. Alfred J. Loser Scholarship Board 258 N. Abbe Rd. Elyria, OH Phone: Fax # Upon receipt of the written verification, a check in the amount of your scholarship award will be made payable to your name and the name of the college/university and then sent directly to the institution. Please allow at least 30 days for the Loser Scholarship Board to process your scholarship award (from the date you submit it to the date it is received.) Plainly, if a payment is due on a specified date by you college/university, be sure to submit your documentation to us 30 days before it is expected. Note: If written verification that you are attending a college/university is not received by the Dr. Loser Memorial Board before November 30, 2016, your scholarship award will not be processed and/or released. Hence, you will FORFEIT YOUR SCHOLARSHIP.