General Motors Scholarship Program Application for 2018-19

GM/EEOC scholarship from Purdue University was made possible through an endowment fund provided by General
Motors. Students, please complete the following application with your information and qualified parent information if
applicable. In addition, attach a resume that includes your work, volunteer, club, extracurricular activities, educational
goals and accomplishments. Students with a GM relationship must submit employment verification from The Work
Number/Equifax. Please note that students must apply every academic year and submit new verification of employment
with each application. Completed application and employment verification are due by January 1, 2018.

Student’s Full Name:

Permanent Address:

Email: Phone:

Major: Anticipated Grad Date:

Cumulative GPA: Classification:

GM Employee Relationship: Spouse Dependent Gender (Optional): Male Female

Ethnicity (Optional): African-American Hispanic Native America Asian Caucasian Other

Outstanding Academic Awards:

Qualified Parent’s Full Name:

Parent Ethnicity (Optional): African-American Hispanic Native America Asian Caucasian Other

Parent Gender: Male Female GM Plant Location:

If I am selected for a scholarship, award or prize, I authorize Purdue University to release my name, major and
hometown to the donor(s) and confirm that all criteria for selection were met: Yes No

Student Signature: Date:

Return the completed application and all required documentation to the Division of Financial Aid by email, mail, or fax.
Your completed resume is part of the required documentation. Applications that do not include this document
will be considered incomplete.

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Division of Financial Aid  Schleman Hall of Student Services, Room 305  475 Stadium Mall Drive  West Lafayette, IN 47907
(765) 494-5050  Fax: (765) 494-6707  scholarshipdfa@purdue.edu  www.purdue.edu/dfa