Dominic Short Memorial Scholarship

Dominic Short Memorial Scholarship / Funds Application
Eligibility

Applicant's need to ensure all items marked with a red star are populated. The scholarship committee will review the application and determine if student is eligible for the drawing of one scholarship. Registered members of Saint Thomas the Apostle parish's children, stepchildren, grandchildren and step-grandchildren are eligible. For School assistance the eligible student must be currently enrolled and attending an approved institution or the student must be accepted by the school and has registered to attend the school. ONE APPLICATION PER CHILD.
Application must be recieved by Tuesday, June 8, 2026. Should there be multiple applications, selection will be by lottery at the June Business Meeting.
Applicant's Name

First NameLast Name
If the application is to offset the cost of medically necessary equipment or device(s), and a balance is due or equipment/device is rented, then only that portion of the form is needing completed. Payment of $500.00 is paid directly to the facility or vendor where the equipment/device is being purchased/rented from. Current balance must exceed the $500.00 limit or rental agreement is for a period longer than the $500.00 value of the award.
Email
example@example.com
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Students Information
Name of Special Needs Child

First NameLast Name
What is this application for?
In-home Assistance Grant
Discribe the Need
Education Information - If education Grant
Name of School
Financial Aid Department Information
Financial Aid Departments Address (Where checks are mailed to)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Financial Aid Departments Phone Number

Area CodePhone Number
Medical Equipment/Device Application

Only If applying for equipment assistance
Discribe the Need
Medical Equipment/Device Vendor Address (Where checks are mailed to)

Name of Vendor

Street Address

CityState / Province

Postal / Zip Code
I AFFIRM THAT ALL STATEMENTS I HAVE INDICATED HEREIN ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. ANY MISREPRESENTATION I HAVE MADE CAN CAUSE FOR THE INVALIDATION OF MY APPLICATION AND SHALL BAR ME FROM RE-APPLYING FOR THE SAME.
Applicant's Signature

Use your mouse to sign your name.
Date Signed by Applicant

MonthDayYear
Date
Should be Empty:

Dominic Short Memorial Scholarship / Funds Application

Eligibility

Application must be recieved by Tuesday, June 8, 2026. Should there be multiple applications, selection will be by lottery at the June Business Meeting.

Students Information

In-home Assistance Grant

Education Information - If education Grant

Financial Aid Department Information

Medical Equipment/Device Application