Acacia Fraternity Scholarship Application

Acacia-Purdue Scholarship Committee

PO Box 3762
West Lafayette, Indiana 47906

Name: _________________________________________________ Birth Date: ___________

Address at College \ Dorm & Room Number ___________________________ _____________Phone: ______________

Email Address: ______________________________Hometown (City, State):__________________________________

High School Attended:_____________________ Graduating GPA: ______________ SAT or ACT Score:___________

Circle All That Apply: Valedictorian Salutatorian Honors Diploma AP Scholar

List all activities (Varsity Sports, Organizations, etc.) Include any positions held while involved:

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College Major Year (Fresh., Soph., Jr., Sr.) Semester/Cumulative GPA Expected Grad. Date

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Circle All That Apply: Honors Program Semester Honors Dean’s List Major Honor Society

List all current campus activities (Varsity / Club Sports, Intramurals, Organizations, etc.) Include any positions held while

involved: ____________________________________________________________________________________________________

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List all Current Community Involvement (Volunteering, Mentoring, etc.):________________________________________________

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Explain why you are seeking this scholarship and why you should receive consideration: _______________________

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Financial Information

Income from Employment: Educational Expenses:

School Year $________________________ Tuition and Fees $________________________

Summer $________________________ Books $________________________

Income from Savings $________________________ Room and Board $________________________

Income from Others $________________________ Books $________________________

Loans $________________________ Transportation $________________________

Other Scholarships $________________________ Misc. (List) $________________________

Misc. (List) $________________________ $________________________

Total Income $________________________ Total Expenses $________________________

Less Total Income $________________________

Difference $________________________

Will this scholarship reduce other scholarships or grants (yes/no)? _____________

Please attach to this scholarship a transcript including all college-level work completed to date (Unofficial).

I hereby certify that I will be enrolled at Purdue University for the period of the scholarship award and, to the best of my

knowledge and belief, the above information and that attached hereto as part of this application is true, complete and correct.

__________________________________________________________ ________________________

Signature of Applicant Date

We appreciate your interest in applying to Acacia Fraternity’s scholarship program. Applications will be reviewed and

selections will be made based on academic merit, campus and community involvement, leadership potential and financial

need.

Applications are to be hand delivered or mailed to the chapter house no later than Monday, August 23rd.