Dr. Alfred J Loser Memorial Scholarship Fund
APPLICATION FOR FINANCIAL ASSISTANCE
Date: __________________________
Application Due Date:
May 1, 2016
Applicant's Name: ________________________________
Academic School Year:
2015-2016_____
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
Applicant
Name:
____________________________________________________________
Address:
____________________________________________________________
_____________________________________________________________
City
State
Zip
____________________________
Telephone No.:
Present Age: ______
________________________
Alt. Phone No.:
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: ___________________________________
Occupation: _________________________
Annual Wages (Father):
_____________________
Annual Wages (Mother):
_____________________
Other income:
_____________________
Annual Wages of Applicant if Employed:
_____________________
Total Family Income:
_____________________
Number of Family Member's presently residing in the home:
____ Ages of Siblings: _____________________
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)
Native American (American Indian)
African American (not of Hispanic origin)
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:
You rank number _____ in a class of ________.
Yes
No
(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:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
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.
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: ____________________
*** 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.
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.
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 1978. After 37 years, the Board has awarded almost 1,300 scholarships totaling,
over $850,000.00.
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 2013.
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.
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. 44035
Phone: 440-326-1968
Fax # 440-326-1972
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.