Form for KEEP Scholarship at Kenyon College

If you have not already done so, read the submission instructions before continuing.

*First Name

Middle Name

*Last Name

Preferred Name

*E-mail Address

Home Phone (XXX-XXX-XXXX)

Mobile Phone (XXX-XXX-XXXX)

*Permanent Home Address

Country
Street
City
Region
Postal Code

Is your mailing address different from your permanent home address?

Yes

*Mailing Address

Country
Street
City
Region
Postal Code

Academic Information

*Type of Applicant

*Enrollment/Start Date (The semester in which you anticipate starting Kenyon.)

*High School Name
If your school is not listed, insert the school's name, city, and state or country.

*CEEB Code (6 characters) If your school is not listed, insert 999997 if your school is outside of the US, 999998 if within the US.

Affirmation

I understand that recipients of this Scholarship must fulfill ALL of the following requirements at Kenyon:
(Prior to submitting, please confirm all have been checked.

Complete the KEEP-STEM summer experience (June 27-August 3), including both courses.

Review academic progress and engagement with KEEP Coordinator at least once per semester for all years.

Complete an ODEI academic workshop or equivalent at least once per semester for all years.

Are you also applying to the STEM program?

If yes, please select your preferred program.
(Please note we may not have the ability to meet your preferred choice.)

*KEEP Scholars uphold and promote Kenyon College's mission of diversity and inclusion. Please identify one or two specific issues of
diversity and inclusion (e.g., race, gender, sexuality, ability) and describe an experience in which you addressed these issues.
(Please limit your response to 250-400 words.)