Name of Applicant
Present Address
City State Zip Code
Email Phone
Duluth Address
Phone
Name of Parent(s)/Guardian(s)
Address of Parent(s)/Guardian(s)
Are you Catholic? YesNo
Are you or one of your parents / guardians a registered member of St. Michael’s Church? YesNo
If so, how long?
High School Graduation Date
Last school attended other than high school Dates attended
To which vocational school, college, or university would you apply this scholarship?
Location
Have you been accepted? YesNo
When will you attend? Major field of study
List the names and phone numbers of two references and your association with them (i.e. teacher, neighbor, employer, family friend).
Name Association Phone
List all activities and organizations in which you now are or have been an active participant during the last four years.
1. SCHOOL and /or WORK EXPERIENCE list Organization/Employer, Dates and Special Recognition/Accomplishments
2. CHURCH and COMMUNITY SERVICE list Organization/Employer, Dates and Special Recognition/Accomplishments
Upload an additional essay:
BY COMPLETING AND SIGNING THIS APPLICATION, I INDICATE THAT THE INFORMATION IS TRUE AND ACCURATE. IN THE EVENT THAT I AM AWARDED A SCHOLARSHIP AND DO NOT USE IT FOR POST-SECONDARY EDUCATION THIS YEAR, I WILL RETURN THE FUNDS. I ALSO GIVE PERMISSION TO ST. MICHAEL’S CHURCH AND TO THE SCHOLARSHIP COMMITTEE TO RELEASE BASIC INFORMATION ABOUT ME (FOR PUBLICITY PURPOSES) IN THE EVENT THAT I AM GRANTED A PERRAULT SCHOLARSHIP.
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