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.

First Name:        Your Google Toolbar can fill this in for you. Select AutoFill 

Middle Name:     Your Google Toolbar can fill this in for you. Select AutoFill  

Last Name:        Your Google Toolbar can fill this in for you. Select AutoFill 

Mailing Address:     Student Identification Number:  

City:                        Your Google Toolbar can fill this in for you. Select AutoFill 

State:                      Your Google Toolbar can fill this in for you. Select AutoFill ALABAMAALASKAAMERICAN SAMOAARIZONAARKANSASCALIFORNIACOLORADOCONNECTICUTDELAWAREDISTRICT OF COLUMBIAFEDERATED STATES OF MICRONESIAFLORIDAGEORGIAGUAMHAWAIIIDAHOILLINOISINDIANAIOWAKANSASKENTUCKYLOUISIANAMAINEMARSHALL ISLANDSMARYLANDMASSACHUSETTSMICHIGANMINNESOTAMISSISSIPPIMISSOURIMONTANANEBRASKANEVADANEW HAMPSHIRENEW JERSEYNEW MEXICONEW YORKNORTH CAROLINANORTH DAKOTANORTHERN MARIANA ISLANDSOHIOOKLAHOMAOREGONPALAUPENNSYLVANIAPUERTO RICORHODE ISLANDSOUTH CAROLINASOUTH DAKOTATENNESSEETEXASUTAHVERMONTVIRGIN ISLANDSVIRGINIAWASHINGTONWEST VIRGINIAWISCONSINWYOMING

Zip:                           

Daytime telephone:  

Evening telephone:   

E-mail:  

Major:    

Expected Graduation Date:

GPA:  

Campus:   ClarkstonDecaturDunwoodyNewtonGPC Online

Class Rank: New StudentFreshmanSophomore

Gender:

  Female
  Male

Ethnicity:

  Hispanic
  Non-Hispanic

Race:

  African American
  Asian American
  Native American

  Multi-cultural

  Pacific Islander

  White

  Other

Citizenship:

US CitizenPermanent 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? YesNo

When are you planning to attend classes?

  Day
  Evening
  Weekend

Reference 1:

First Name:  

Last Name:  

Title:  

Mailing Address:     Your Google Toolbar can fill this in for you. Select AutoFill 

City:                        Your Google Toolbar can fill this in for you. Select AutoFill 

State:                      Your Google Toolbar can fill this in for you. Select AutoFill ALABAMAALASKAAMERICAN SAMOAARIZONAARKANSASCALIFORNIACOLORADOCONNECTICUTDELAWAREDISTRICT OF COLUMBIAFEDERATED STATES OF MICRONESIAFLORIDAGEORGIAGUAMHAWAIIIDAHOILLINOISINDIANAIOWAKANSASKENTUCKYLOUISIANAMAINEMARSHALL ISLANDSMARYLANDMASSACHUSETTSMICHIGANMINNESOTAMISSISSIPPIMISSOURIMONTANANEBRASKANEVADANEW HAMPSHIRENEW JERSEYNEW MEXICONEW YORKNORTH CAROLINANORTH DAKOTANORTHERN MARIANA ISLANDSOHIOOKLAHOMAOREGONPALAUPENNSYLVANIAPUERTO RICORHODE ISLANDSOUTH CAROLINASOUTH DAKOTATENNESSEETEXASUTAHVERMONTVIRGIN ISLANDSVIRGINIAWASHINGTONWEST VIRGINIAWISCONSINWYOMING

Zip:                           

Telephone:  

E-mail:  

Reference 2:

First Name:  

Last Name:  

Title:  

Mailing Address:     Your Google Toolbar can fill this in for you. Select AutoFill 

City:                        Your Google Toolbar can fill this in for you. Select AutoFill 

State:                      Your Google Toolbar can fill this in for you. Select AutoFill ALABAMAALASKAAMERICAN SAMOAARIZONAARKANSASCALIFORNIACOLORADOCONNECTICUTDELAWAREDISTRICT OF COLUMBIAFEDERATED STATES OF MICRONESIAFLORIDAGEORGIAGUAMHAWAIIIDAHOILLINOISINDIANAIOWAKANSASKENTUCKYLOUISIANAMAINEMARSHALL ISLANDSMARYLANDMASSACHUSETTSMICHIGANMINNESOTAMISSISSIPPIMISSOURIMONTANANEBRASKANEVADANEW HAMPSHIRENEW JERSEYNEW MEXICONEW YORKNORTH CAROLINANORTH DAKOTANORTHERN MARIANA ISLANDSOHIOOKLAHOMAOREGONPALAUPENNSYLVANIAPUERTO RICORHODE ISLANDSOUTH CAROLINASOUTH DAKOTATENNESSEETEXASUTAHVERMONTVIRGIN ISLANDSVIRGINIAWASHINGTONWEST VIRGINIAWISCONSINWYOMING

Zip:                           

Telephone:  

E-mail:  

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.