Houston Scholarship Application

Name*
First Middle Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Home/Permanent Address (do not list campus address)*
Street Address Address Line 2 City State ZIP Code
Email*
Enter Email Confirm Email
Phone*
County (e.g. Tippecanoe County)*
Purdue ID (10 digits, no dashes. e.g. 0012345678)

Parent(s') Name(s)*
Address (if different than your home/permanent address listed on previous page)*
Same as Home/Permanent Address

Street Address Address Line 2 City State ZIP Code
Parent Email(s)

Please list any family members that graduated from Purdue as well as their relationship to you.
What activities do you participate in? Include clubs, organizations, leadership roles, community service, work experience, and any recognition or awards that you have received.

Why would you like to attend Purdue University?
Why did you choose to attend Purdue University?
What are your educational goals? How do you think Purdue will prepare you for success, both in your chosen field of study and in general?
Please provide any additional information that you would like the selection committee to consider.

Consent*
I agree to have my information released for club review and publication if chosen and that the information I provided is true and accurate.*
Consent*
I agree that my information may be released to officials at Purdue University in order to complete the review of my application and to confirm eligibility criteria.*
Consent*
I agree to send a letter of appreciation to the donor of my scholarship and to participate in events associated with any scholarship, award, or prize I may receive.*
Consent*
I understand that Purdue University’s FAFSA (Free Application for Federal Student Aid) priority filing deadline is March 1. To be considered for club scholarships that include a need component, I agree to have my FAFSA completed no later than the filing deadline.*
Consent*
I understand that additional requirements may exist for Some Purdue Alumni Clubs beyond the information provided in this application. If requested, I will submit a letter of recommendation or submit a current transcript directly to the club for further consideration.*