Circle one:
Walter J. Taranko Scholarship or MASL School Library Ed. Tech. Scholarship

DATE:

Name:

Address:

City: ......... ......... ..State:......... ......... ..Zip:

Phone: (H)......... ......... ......... ......... ((W)

Email:

Educational Background





Employed: YES......... ......... ..NO......... ......... ..Position:

Place of Employment:

Work Address:

City: ......... ......... ..State:......... ......... ..Zip

Work Phone:

Course or Program enrolled in:


School:

Date of proposed course / workshop / conference:

Other financial assistance (sources and amounts):

Will you be attending as part of a team from your place of employment?
YES NO

Please provide, as part of this application:

One professional reference,
One personal reference
A thoughtful one-page essay describing your long term goals.

Please feel free to attach additional pages as necessary.

Applications should be mailed to:

Barbara Hammond bhammond@msad43.org
Library/Media Specialist
21 Cross St.
Mexico, ME 04257