Welcome to

St. Dominic High School

Dolly Reller Scholarship   
St. Dominic High School
31 St. Dominic Drive
O’Fallon, MO   63366

							Social
Student’s Name: ________________________________	Security: ________________________

Street Address:  __________________________________________ Phone:  ____________________

City:____________________________________       State:  _________    Zipcode: _______________

Parent’s Name:		  Father:____________________              Mother: ____________________
Parent’s Daytime Number:  Father:____________________              Mother: ____________________
									Number of
In what parish is your family registered? _______________________________ 	Children: _________

School student attends presently :    _________________________________  Grade:_________

All applicants for this scholarship must fill out and return the PSAS Student Aid form. Go to SDHS web site
www.stdominichs.org, click PSAS form and print.  Or form may be obtained from school office.

PART I SHOULD BE SENT TO THE SCHOOL AND PART II TO THE COMPANY.

____	I have mailed my PSAS Student Aid form on ________________.  (fill in date mailed)

1.	Explain briefly your financial need for this scholarship.                                   

2.	Explain the service that you have given in the past two years (to parish, school, community) and what 
	that has meant for you.

THIS FORM SHOULD BE COMPLETED AND RETURNED BY TUESDAY, MARCH 25, 2008 TO:

Dolly Reller Scholarship
St. Dominic High School
31 St. Dominic Drive
O’Fallon, MO   63366