| APPLICATION YEAR 2012 TUITION SCHOLARSHIP GRANT ($5,000) The Alumnae Association of St. Mary's Dominican College, Inc. and the St. Mary's Dominican Collage Alumnae Scholarship Fund 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: Alumnae Association, 7300 St. Charles Ave., New Orleans, LA 70118 (Deadline: March 9, 2012) |