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Norbert Rothermich
Memorial Scholarship
St. Dominic High School
31 St. Dominic Drive
O’Fallon, MO 63366

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Student’s Name:________________________________________________ Security:__________________

Street Address:___________________________________________________ Phone:__________________
_
City:______________________________________________ State: __________ Zip: __________________

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 website www.stdominichs.org, click PSAS form and print. Or form may be obtained from school office.
PSAS Part I form should be sent to St. Dominic Part II should be sent to the company (PSAS).

____I have mailed my PSAS Student Aid form on _____________________. (fill in date mailed)

____ Current GPA (Minimum of “C” required)

1. What occupation interests you as a possible career choice and why?



2. List extra-curricular activities (organizations, sports, clubs, etc.), in which you have been involved and how long? Which of these is most meaningful? Why?




3. List service activities in your parish and community in which you have been involved in the last two years. What has this meant to you?





4. Explain briefly your financial need for this scholarship.





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

Norbert Rothermich Memorial Scholarship
St. Dominic High School
31 St. Dominic Drive
O’Fallon, MO 63366