Marian University
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San Damiano Scholar Interview Day Registration

* denotes required fields

Registration must be submitted by Sunday, January 29, 2012.

Part One - Personal Information
Personal information is never shared with groups not associated with Marian University. Review our privacy policy for more information.

*First Name:  
*Last Name:  
Middle Name
*E-Mail Address:  
*Home Telephone
(include area code)  
*Cell Phone
(include area code)  
*Can you receive text messages? Yes    No   
*May we send you text messages related to the San Damiano Scholars Program? Yes    No   
*Number of Persons Attending.
(excluding yourself)
*Names of Persons Attending
(Mom, Dad, Siblings, etc.)
*T-Shirt Size
*List any awards received or nominated: (i.e., captain of team, academic all state/conference, nominated for Lugar Leadership Symposium, Serra Club Essay winner
*Hometown Newspaper Name: (Scholarship award winner’s hometown newspaper will be notified in May)

Part Two - Interview Day Preference
(Please choose which interview day you prefer.)

First choice


Part Three - Publicity Release
(Scholarship award winner’s home parish, pastor, and youth pastor are notified in May)

I grant Marian University permission to use photographs of me and my name in publications produced by the organization, web sites owned by the organization, or public relations activities conducted by the organization for the purpose of promoting Marian University.

(Due to the nature of this application, your e-mail address will act as your signature. If you do not have an e-mail account, then please type your first and last name.)

*Signature:  
*Date: