Kenny Beck "Changes in Latitude: Memorial Scholarship

This scholarship is available to a graduating senior from Columbia City High School who intends to attain a degree from Purdue University. Applicants should have a 2.5 or better grade point average.

Application Deadline:

Application Due April 15

Kenny Beck

Instructions

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Please review this form and have your responses ready. It is advised to prepare your answers in advance. You may also copy and paste your answers from Microsoft Word or other text based programs.

Applicant Information

Name*

Address*

City State Zipcode*

Date of Birth*

Telephone Number*

Email*

Re-enter Email*

Last four digits of your social security number

Tell something interesting about yourself.*

Upload a picture of yourself.*

Family Information

Father

Please check whom you are living with

Address

Place of Employment/Occupation

Education

Mother

Please check whom you are living with

Address

Place of Employment/Occupation

Education

Number of siblings and their ages*

Financial Information

Total household income for the past calendar year*

Please detail how you plan to finance your education and note how much support you will be receiving from sources such as relatives, employment, scholarships, grants etc.*

Extracurricular Activities

Please list any clubs, teams, or groups (school, church, community, etc) you have been involved in and check the years you have actively participated in the program*

Work Experience

Please provide your employment history*

College Plans

Planned Field of Study*

What factors have contributed to your decision to attend Purdue and pursue the aforementioned planned field of study?*

Grade Point Average*

Short Essay

Kenny Beck loved life. He loved his family, his friends, and the kids he taught. He also loved the music of Jimmy Buffet! Please take a moment and think about this line from Jimmy Buffet's song He Went to Paris, and write a few lines about the message the following line resonates:

"...some of it's magic, some of it's tragic, but I had a good life all the way."

Short Essay*

Transcript

Please provide a copy of your transcript*

Certification

I hereby affirm that the information provided in this application is accurate and complete to the best of my knowledge*

Security

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