Welcome to

St. Dominic High School

Redford Michael Perrine
Memorial Scholarship
St. Dominic High School
31 St. Dominic Drive
O’Fallon, MO 63366

Social
Student’s Name: ________________________________ Security: ________________________

Grade at St. Dominic: 11th or 12th Current GPA: _________________
(circle grade)
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: _________

This scholarship will be applied to college/university or community college tuition and is open to 11th and 12th grade art students at St. Dominic High School with a GPA of 2.0 or above.

Student applicant should answer the following.

1. Please name the art courses already completed at St. Dominic:

Course: _____________________________ Grade: __________
Course: _____________________________ Grade: __________
Course: _____________________________ Grade: __________
Course: _____________________________ Grade: __________

2. Please name the art course in which you are presently enrolled:

Course: _____________________________ Grade: __________
Course: _____________________________ Grade: __________

3. What college/university or community college do you plan to attend and what will your major be?

4. Name the occupation that interests you as a possible career choice and explain why.

5. What part does art play in your life and how does it influence you? (please type your answer on a separate
sheet of paper)

Finalists will be asked to submit a portfolio of 10 artworks for review. This form should be completed and returned by Tuesday, March 25, 2008 to:

Redford Michael Perrine Memorial Scholarship
St. Dominic High School
31 St. Dominic Drive
O’Fallon, MO 63366