Purdue Alumni Club of Chicago
2015 Scholarship
Instructions for Applicants
Incoming Freshmen (Fall 2015)
Eligibility:
Applicants must have accepted admission to Purdue University for the Fall 2015 semester
and enroll as a full-time student beginning in Fall 2015. The Scholarship is merit based, but
need is considered in the overall evaluation of each applicant. PCC strives to award
deserving recipients who are well-rounded, who the Scholarship Committee believes will
succeed at Purdue and who embrace its traditions and spirit.
Applicants must reside in the Chicago Club area (Illinois only). Applications should be
completed and submitted by the student, not counselors, parents or others.
PCC may request additional information or interviews with applicants. Applicants will be
notified via e-email if information is sought or if an interview is requested.
Deadline:
Applications may be submitted (based on e-stamped or postmark) between January 2,
2015 and January 9, 2015. Applications may be submitted electronically or by U.S. mail.
Information for submission is included at the end of the application form.
Sponsors:
Each applicant must be sponsored by a current member of the Purdue Alumni Association
who lives in the PCC area.
Electronic submissions via e-mail:
If an applicant submits his or her materials via e-mail, all documents must be attached to a
single e-mail. The e-mail must be entitled as follows:
“2015 PCC Scholarship Application for” First Name Last Name
Applicants will receive an electronic confirmation of receipt; please allow a few days for
confirmations. If you submit an application and do not receive a response, please follow up
by e-mailing scholarship@puchicago.org.
Submissions via regular mail:
Applicants submitting their materials via regular mail must include any supporting
documentation with the application. Applicants will receive an e-mail notification when their
application is received.
Award of Scholarship(s):
The amount of the award has not yet been determined. Scholarship awards are tendered
by the Purdue Bursar’s Office.
Winners and sponsors will be notified once a decision is made, and winners will be
recognized at PCC’s Annual Meeting (held mid-late Spring) and may also be recognized at
other PCC events. All applicants are encouraged to attend the PCC Annual Meeting.
Scholarship Winners may be profiled by PCC or PAA in its publications.
Purdue Club of Chicago
Scholarship Application
Application Deadline: January 9, 2015
Electronic or typed applications are preferred.
Please direct all inquiries to scholarship@puchicago.org.
PERSONAL INFORMATION
First Name:
Middle Name:
Last Name:
E-mail address:
Current
Street Address:
City, State & Zip:
Phone Number:
(Please indicate if the number is a home, work or cell phone number)
Parent(s)/Guardian(s) Names and Address(es):
Have you committed to attending Purdue as an incoming freshman for the Fall of 2015?
EDUCATIONAL BACKGROUND
(if you have attended multiple high-schools or attended semesters abroad, please provide
information regarding each school/program attended)
High-School:
Address:
City, State & Zip:
Is the high-school public or private?
School District:
--------------------------------------------------------------------------GPA:
_______ out of _______
ACT score:
_______ out of _______
SAT score:
_______ out of _______ Math Score: _______ English Score: _______
NOTE: in all the areas below you can add rows/space as needed.
HONORS & ACTIVITIES
List/describe any scholastic honors or awards you have received in high-school.
Honor or Award
Received From
Date
List/describe any extracurricular activities, including any volunteer or community service work, you
engaged in while in high-school. Please include the name of the organization, a contact person,
phone # and e-mail address, a description of your position, the years you were involved and the
total number of hours devoted to the organization.
Activity
Position Held
Dates of Involvement
PURDUE PLANS & GOALS
Which academic program(s) have you applied to at Purdue?
Which academic program(s) have you been accepted to for Fall, 2015?
Do you plan to participate in a work/study program?
What major(s) or curriculum do you plan to pursue while at Purdue? Why?
What do you expect to get out of your time at Purdue? (100 word limit)
Describe the activities you anticipate being involved with at Purdue outside of your academic
studies: For example, are you interested in intramural sports, marching band, student government,
etc.? You may list general interests without knowing the name of the actual campus organization.
EMPLOYMENT
Employer
Job Description/Title
Dates of Employment
Hours (on average)
worked per week
FINANCIAL INFORMATION
SCHOLARSHIPS AWARDED BY PURDUE
(include all types)
Name/Type of
Scholarship
Indicate
amount(s)
applied for and
the amount
awarded
Is the award
renewable? If Y
provide term of
renewability.
Status (received,
pending, decision
expected by, etc.)
OTHER GRANTS/SCHOLARSHIPS
List any grants/scholarships/loans you have applied for and are either awaiting status or have
received.
Name of Grant or
Scholarship
Indicate
amount(s)
applied for and
the amount
awarded
Is the award
renewable? If Y
provide term of
renewability.
Status (received,
pending, decision
expected by, etc.)
How do you presently anticipate paying for your first year of school?
(As of the date of application)
Source of Funds
Percentage
Parents
Students own funds
Loans
Scholarships
Grants
Other (please describe)
Total:
100%
ESSAY
Note: This essay is evaluated for quality as well as content, so be sure to check for spelling and
grammar.
How do you expect to contribute to your profession, society and Purdue within your first five years
after graduation? (250 word limit)
SPONSOR
Name of Sponsor:
Current Address:
Email address (for verification of sponsorship only):
Year/School Graduated from Purdue:
Current Member of Purdue Alumni Association?
VERIFICATION & ACKNOWLEDGEMENT
How did you hear about the scholarship program? Check all that apply:
______
______
______
______
______
My sponsor for this application told me about it.
My high school counselor told me.
My parent(s) told me about it.
On the Purdue Club of Chicago website.
Other: (Please describe)
Letters of recommendation and high-school transcripts are not required, but all information
submitted by the applicant will be considered by the Scholarship Committee in its decisionmaking process.
Signatures: E-signatures are accepted, as are scanned copies of the application; e-signatures by
parent or guardian must be accompanied by contact information verification purposes.
By signing below, I acknowledge that the information provided in this
above application is correct to the best of my knowledge and confirm
that I satisfy all of the criteria for the Purdue Club of Chicago
scholarship(s) for which I am applying. Furthermore, I authorize Purdue
University to release personally identifiable information from my
education record to the Purdue Club of Chicago for the purposes of
scholarship selection, and scholarship donors and/or the media for
publicity purposes regarding the awarding of a scholarship. This could
include items such as my class, major and GPA but not my PUID.
If I am selected for a scholarship, award or prize, I authorize Purdue
University to release my name, major and hometown to the donor(s) and
confirm that all criteria for selection were met.
Yes ____ No ___
_
___________________
Signature of Applicant
Printed Name: __________________________
____________________
Date
PUID:
If the applicant is under the age of 18 please provide a signature below:
Signature of Parent or Guardian
Date
Contact info: (please provide name, phone number, email address)
Postmark Deadline: January 9, 2015
E-mail Deadline: January 9, 2015
Submit completed application to:
Via Mail
or
The Purdue Club of Chicago
225 W. Washington Street, Suite 1120
Chicago, Illinois 60606
Via E-mail
scholarship@puchicago.org
For additional information visit www.puchicago.org.