APPLICATION YEAR 2014 TUITION SCHOLARSHIP GRANT ($5,000)
                                 
Presented by  The Alumnae Association of St. Mary's Dominican College, Inc.

NAME: ______________________________________________________________________________________

ADDRESS: ___________________________________________________________________________________

TELEPHONE: (     ) ____________________________ Date of Graduation _______________________________

Name of mother/father and/or grandmother/grandfather who is alumna/us of St. Mary's Dominican College:

_____________________________________________________________________________________________
First                                                        Middle/Maiden                                        Last       

My grade point average is _________  Class rank is ______ of __________________________________________.

I have participated in the following extracurricular activities during high school:
             (Use separate sheet if necessary)

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

I will enroll in a Cathonlic college or university:        Yes / No

Name and address of college or university:  _________________________________________________________

                   ___________________________________________________________________________________
                 
                   ___________________________________________________________________________________

Write a 100 word paragraph stating why you want to enroll in a Catholic college or university.  (Use separate sheet)

APPLICANT'S SIGNATURE _____________________________ Date _________________________________


To be completed by principal or counselor of high school applicant is currently attending:
(Type or print)
**********************************************************************************************

The above information is correct:

                                                                                                                                   
   Circle One
Name: ___________________________________________________________  Principal/Counselor
_
Name of High School: ___________________________________________________________________________

Address : _____________________________________________________________________________________
 
                _____________________________________________________________________________________

Tel. No.  _________________________________

PRINCIPAL/
COUNSELOR'S
SIGNATURE   ___________________________________________  Date ________________________________
                Mail to: SMDC Alumnae Association, 7701 Walmsley Ave.,  New Orleans, LA  70125
                                                             (
Deadline:  January 10, 2014)