Purdue Club of Southwest Michigan
(Berrien, Cass and Van Buren Counties)
Scholarship Application 2016: Applicants for the scholarships must be accepted for admission by Purdue University and reside in
Berrien, Cass, or Van Buren Counties, Michigan. The application form must be typed or printed and returned postmarked no later that
March 1, 2016 to the addresses listed below. Awardees will be notified on or before May 1, 2016
for awards for the 2016-2017 school year.
Last Name ________________________ First Name ______________________ Middle Initial _________________
Street Address ___________________________________ Phone ______________________________________
City __________________________ County ________________________, MI Zip ________________________
Parent's Names ____________________________Email Address ________________________________________
Name/Location of High School ___________________________________________________________________
HS Class Rank _________ HS Grade Point Average __________ Combined SAT or ACT Score ___________________
List the Purdue Campus you plan to attend: __________________________________________________________
What is your course of study (Major/Minors)? ________________________________________________________
College Credit Hrs. Completed? _______ hrs. College GPA _______ Expected College Graduation __________________
Previous Work Experiences (list employer, length of employment, job duties – Use extra sheet of paper if needed)
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
List your major academic honors and important high school and/or college extra-curricular achievements on an attached sheet of paper.
Required Essay: Attach a typed essay of between 450-500 words, double spaced, which includes your name and date in the heading.
Answer the following two questions. Applicants using the same essay responses from any previous year will be disqualified.
What are your reasons for selecting Purdue University?
What do you hope to accomplish in the next four years while attending Purdue?
Permission Request if Awarded a Scholarship: If I am selected for a scholarship, award or prize, I authorize Purdue University to
release my name, major and hometown high school to the donor(s) and confirm that all criteria for selection
were met. _____Yes ______No
Signature: ______________________________________ Date: ___________________________________
Printed Name: __________________________________ PUID: (if known)_____________________________
Send via email or U.S. Mail the completed application to: Scholarship Committee, c/o Glenn Youngstedt.
3395 Notre Dame Path, Stevensville, MI 49127 or glennyoungstedt@aol.com