The Jack Gargalino Memorial Foundation Scholarship Application Form

The Jack Gargalino Memorial Foundation Scholarship Application
Founded in 2022, the Jack Gargalino Memorial Foundation is a 501(c)(3) charity that provides financial assistance to individuals pursuing a career as a public servant.

Qualifications:
- Legal U.S. citizen
- Age 17 or older.
- Enrolling/enrolled in a college or vocational/technical school leading to a career as a public servant, including: a law enforcement-related field (not including law school), firefighter, EMS technician, paramedic, nurse, teacher.
- Submit a typewritten essay (on 8½ x 11 paper) of 200 words or fewer outlining why you have chosen a career as a public servant.
- Provide three letters of recommendation from three different sources.
- Scholarship recipients will be asked to attend the Foundation’s annual golf outing during the award year, when reasonably possible, and to provide brief annual updates that may be shared with donors and supporters to demonstrate the impact of the scholarship program.
*Persons may reapply for succeeding years
Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Family Information
Name of Mother or Guardian (applicant under 18)

First NameLast Name
Mother's Job/Position (applicant under 18)
Address of Mother (applicant under 18)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Father (applicant under 18)

First NameLast Name
Father's Job/Position (applicant under 18)
Address of Father (applicant under 18; if not the same as above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is anyone in your immediate family an active or retired member of law enforcement?

Other
If "Yes" to above, please indicate which family member(s) and where they served

Financial Information
Are you a dependent of your Parents?
Your Family's Joint Annual Income
Have you tried applying for scholarships with other organizations previously?
Have you been awarded any other scholarships as of the date of this application?
Any information that might support your answer above

Scholarship Recipient Participation and Updates

If selected for a scholarship award, I understand that I will be asked to attend the Jack Gargalino Memorial Foundation’s annual golf outing during the year in which the scholarship is awarded, when reasonably possible. I understand that school, work, clinical schedules, military obligations, distance, transportation, or other circumstances may prevent attendance.

I also understand that scholarship recipients are asked to provide a brief annual update regarding their education, career progress, and continued interest in public service. These updates help the Foundation share the impact of donor support and may be used in Foundation communications, including the Foundation website, social media, printed materials, and future fundraising events.

By accepting a scholarship award, I agree to allow the Foundation to share my name, scholarship year, general educational/career update, and any photo or statement I choose to submit for Foundation-related purposes, unless otherwise requested in writing.

Applicant Affirmation

I affirm that all statements I have indicated herein are true and correct to the best of my knowledge. I understand that any misrepresentation I have made may result in the invalidation of my application and may bar me from re-applying for this scholarship.
Applicant's Signature
Name of Applicant

First NameLast Name
Date Signed by Applicant

MonthDayYear
Date
Phone Number

Area CodePhone Number
Attachments
Attach Typewritten Essay

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Attach Letters of Rec.

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Should be Empty:

The Jack Gargalino Memorial Foundation Scholarship Application

Academic Information

Education Information

Family Information

Financial Information

Attachments