The Clarence & Barbara Taliaferro Scholarship Form

THE CLARENCE & BARBARA TALIAFERRO SCHOLARSHIP PROGRAM

Who Can Apply?

To Qualify, Applicants Must:
- Have a cumulative grade point average of 2.5 or higher on a 4.0 scale.
- Fall into one of the following categories:
  - High school seniors who have applied to and enrolled in a full-time course of study at an accredited four-year college or university.
  - College freshmen, sophomores, or juniors currently enrolled in a full-time course of study at an accredited four-year college or university.
  - Community college students enrolled in a full-time course of study.
- Demonstrate financial need according to the Free Application for Federal Student Aid (FAFSA) and the Student Aid Report (SAR) form
Selection Process

The Selection Committee reviews all applications to determine the most qualified applicants. Scholarships are awarded based on:
- Academic potential
- Financial need
- Participation and leadership in school and community activities
- Short answers and one essay response
Award Amount

The Clarence & Barbara Taliaferro Scholarship will award $1,000 to each recipient.

Payment of Award
- On or around June 20th, a check for $500 will be mailed to the recipient’s college or university.
- The second check will be mailed on or around December 1st.
- Checks are made payable to the school with the recipient’s name and Student ID number included.
Obligations & Responsibilities
- Scholarship recipients must notify the Committee of any changes in address, school enrollment, or other relevant information.
- Applicants are responsible for admission to an accredited four-year college or university and meeting its entrance requirements.
- Recipients must enter school no later than the fall term of the year of the award.
Questions/Concerns

For questions about The Clarence & Barbara Taliaferro Scholarship Program, email SCHOLARSHIP@TheTaliaferroFoundation.org

Applicants Must Upload the Following:
- A current color headshot
- Completed Application Form
- Most recent official transcript (must be mailed to the address below)
- College applicants: transcripts from all previously attended institutions (transferred credits included)
- Official ACT or SAT score report
- Two or three signed letters of recommendation on official letterhead
  - College applicants must include at least one recommendation from a faculty member in their field of study
- FAFSA Student Aid Report
High School Applicants Only:
- Copy of diploma or graduation certificate with class ranking
- Copy of college/university acceptance letter
Please mail your official transcripts to:

The Clarence & Barbara Taliaferro Scholarship Program

Attention: Scholarship Committee

P. O. Box 331134

Nashville, TN 37203

APPLICATIONS WILL BE ACCEPTED BETWEEN March 1 – June 1

GENERAL BACKGROUND INFORMATION

Application must be completed in its entirety.
Applicant’s Full Name*

First NameLast Name
Date of Birth *

MonthDayYear
Applicant’s Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone*
Please enter a valid phone number.
Secondary Phone
Please enter a valid phone number.
Email*
example@example.com
Parent / Legal Guardian Name*
Social Media Information:
Facebook
Twitter
Instagram
Snapchat
TikTok
Other:

COLLEGE OR UNIVERSITY YOU PLAN TO ATTEND
Name of College*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

EDUCATIONAL BACKGROUND INFORMATION

Please list the PREVIOUS school(s) you have attended:

Rows	Name of Institution	Full Address & Phone Number	Dates Attended	Grade Point Average
1
2
3
4
5
6
7
8

Graduation Month/Year
Major/Minor (if applicable)
SAT Results

Rows V M W

Results
ACT Results (if applicable)
List all extracurricular school activities below:
List and describe your leadership experience(s):
List any awards and/or honors you have received. Include the year the honor was received:
SPECIAL CONSIDERATIONS (can include some of the following: death of a student’s parent or guardian; disability of a student; or other unusual circumstance(s):

Rows	V	M	W
Results

EMPLOYMENT HISTORY

List your last three employers in the space provided.
ONE
Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Role
Dates of Employment
TWO
Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Role
Dates of Employment
THREE
Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Role
Dates of Employment

REFERENCES

List the names and contact information of the THREE people who will be writing letters of recommendation on your behalf. These individuals should NOT be related to you.
ONE
Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Number*
Please enter a valid phone number.
Secondary Number
Please enter a valid phone number.
Email*
example@example.com
TWO
Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Number*
Please enter a valid phone number.
Secondary Number
Please enter a valid phone number.
Email*
example@example.com
THREE
Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Number
Please enter a valid phone number.
Secondary Number
Please enter a valid phone number.
Email
example@example.com

Document Upload
A current color photo(headshot)*

Photo Use Disclaimer: By submitting your application, you acknowledge and agree that if selected as a scholarship recipient, your submitted photo may be used for promotional purposes, including but not limited to being posted on our website and social media platforms.
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College Acceptance Letter

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Official ACT or SAT score report

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Two or Three signed letters of recommendation submitted on official letterhead*

COLLEGE APPLICANTS: We require at least one recommendation from a faculty member in your field of study. The second letter of recommendation should be from someone who can provide insight into your personal character, potential, motivation, and ability to successfully complete a rigorous course of study. If you choose to include a third letter of recommendation it should be from a teacher or mentor.
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FAFSA Student Aid Report

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High School Applicants Only: - A copy of your diploma/graduation certificate and indication of class ranking - A copy of your college or university acceptance letter

FAFSA Student Aid Report
Cancelof

SHORT ANSWERS
1. Briefly describe your educational and career goals. *
1. Describe what makes you the perfect candidate for this scholarship? *

500 WORD ESSAY

Must be 500 words exactly.
With the world around us ever changing, in what way(s) do you believe you will use your college degree to foster positive change?*

0/500

SCHOLARSHIP INFORMATION

List ALL scholarships, financial aid, or other financial assistance you have been awarded for your college education :

Rows	Name of Scholarship	Name & Address of person/entity giving the scholarship	Amount of Scholarship
1
2
3
4
5
6
7
8

Please provide a list of all colleges/universities to which you have applied:

Rows	Name of Institution	Full Address & Phone Number	Accepted? Yes / No	If yes, provide a copy of letter
1
2
3
4
5
6
7
8

Application Checklist
Please ensure all items below are completed and included before submitting your application:
- Completed Application Form
- Two Letter(s) of Recommendation Uploaded
- Color Photo (headshot) Uploaded
- Transcript or Academic Records Mailed to:
The Clarence & Barbara Taliaferro Scholarship Program
Attention: Scholarship Committee,
P. O. Box 331134
Nashville, TN 37203
- All Items uploaded and mailed by June 1st

Signature
By signing below, I certify that all information provided in this application is true and complete to the best of my knowledge. I understand that any false or misleading information may disqualify me from consideration.

I also acknowledge and agree that if I am selected as a scholarship recipient, my submitted photo may be used for promotional purposes, including on The Taliaferro Foundation website and social media platforms.
Applicant Name *
Date*

MonthDayYear
Applicant Signature*
Should be Empty:

GENERAL BACKGROUND INFORMATION

Social Media Information:

COLLEGE OR UNIVERSITY YOU PLAN TO ATTEND

EDUCATIONAL BACKGROUND INFORMATION

EMPLOYMENT HISTORY

ONE

TWO

THREE

REFERENCES

ONE

TWO

THREE

Document Upload

SHORT ANSWERS

500 WORD ESSAY

SCHOLARSHIP INFORMATION

Application Checklist

Signature