Servant Leaders Scholarship Application
                              Missouri Mu Chapter of Phi Kappa Theta at Missouri S&T
                                                    The National Catholic Fraternity
          Sponsored by the Order of Cardinal Mercier Educational Endowment Foundation

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First Name *
Last Name *
Mobile Phone Number *
Permanent Personal Email (e.g.,,, etc.) *
Address *
City, State, Zip Code *
Parents' Name(s) *
High School, City, State *
High School Graduation Date *
Cumulative GPA (Out of 4.0) *
SAT Score (if applicable)
ACT Score (if applicable)
Service & Church Volunteer Activities *
Leadership Experiences *
Work Experiences *
What goals are you planning to achieve during your college career? *
When is your A&R day?
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Please provide three references, your relationship to them and their contact information (email, phone). *
How did you hear about our scholarship? (Check all that apply) *
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