GPC Peach State LSAMP Scholars Application

In order to apply, please submit a completed application which includes an essay

and two letters of reference.  Please send reference letter via email to  Margaret Major (margaret.major@gpc.edu)  or the Peach State LSAMP faculty advisor on your campus.

Personal Data

First Name:       

Middle Name:      

Last Name:       

Student Identification Number:

Mailing Address:    

City:                       

State:                      ALABAMA ALASKA AMERICAN SAMOA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FEDERATED STATES OF MICRONESIA FLORIDA GEORGIA GUAM HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARSHALL ISLANDS MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA NORTHERN MARIANA ISLANDS OHIO OKLAHOMA OREGON PALAU PENNSYLVANIA PUERTO RICO RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGIN ISLANDS VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING

Zip:                         

Daytime telephone:

Evening telephone: 

E-mail:

Major:  

Expected Graduation Date:

GPA:

Campus:   Clarkston Decatur Dunwoody Newton GPC Online

Class Rank: New Student Freshman Sophomore

Gender:

Female
Male
 

Ethnicity:

Hispanic
Non-Hispanic
 

Race:

African American
Asian American
Native American

Multi-cultural

Pacific Islander

White

Other
 

Citizenship:

US Citizen Permanent Resident

You must have every intention of graduating from one of the participating universities in no more than five years with a baccalaureate degree in a STEM major.

Please select the institution(s) you will be willing to attend:

 

Fort Valley State University
Savannah State University
Southern Polytechnic University
The University of Georgia

Kennesaw State University

Georgia Tech

Are you a Hope Scholar? Yes No

When are you planning to attend classes?

Day
Evening
Weekend

References

Reference 1:

First Name:

Last Name:

Title:

Mailing Address:    

City:                       

State:                      ALABAMA ALASKA AMERICAN SAMOA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FEDERATED STATES OF MICRONESIA FLORIDA GEORGIA GUAM HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARSHALL ISLANDS MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA NORTHERN MARIANA ISLANDS OHIO OKLAHOMA OREGON PALAU PENNSYLVANIA PUERTO RICO RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGIN ISLANDS VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING

Zip:                         

Telephone:

E-mail:

Reference 2:

First Name:

Last Name:

Title:

Mailing Address:    

City:                       

State:                      ALABAMA ALASKA AMERICAN SAMOA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FEDERATED STATES OF MICRONESIA FLORIDA GEORGIA GUAM HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARSHALL ISLANDS MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA NORTHERN MARIANA ISLANDS OHIO OKLAHOMA OREGON PALAU PENNSYLVANIA PUERTO RICO RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGIN ISLANDS VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING

Zip:                         

Telephone:

E-mail:

Essay

Please submit an essay, no more than 250 words, describing your career goals and how you think this program will assist you in reaching your goals.