DETROIT AUTOMOTIVE PROJECT RAINBOW PUSH EXCEL –

GENERAL MOTORS FOUNDATION SCHOLARSHIP APPLICATION FORM 2012
(Please Type or Print. Submit 5 copies of Documents. Include one (1) Headshot Photo with application)
A. Personal Information
1. Full Name (Last, First, Middle) _________________________________________________
2. Birth Date _____________________3. Gender _______4. U.S. Citizen: YES ___
5. Cell Phone __________________________6. Home Phone __________________________
7. E-mail ____________________________________________________________________
8. Current (School) Mailing Address
____________________________________________________________________________
City_____________________ State__________________Zip Code____________
________________________________________________________________________
9. Permanent Mailing Address
____________________________________________________________________________
City ____________________________Zip Code_______
10. Contact Person (i.e. Parent, Guardian) _________________________________________
Email: ____________________________________________Phone:____________________
B. Academic Information
1. University/College_______________________________ ________________________
2. Major/Field of Study (Interest) _____________________________________________
3. Class Standing (circle one): 1st year / 2nd Year/3rd Year /4th year/Graduate/Other
4. Current GPA _________
5. Previous academic honors, fellowships and awards ______________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
6. Please describe any interests and/or hobbies you have ___________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
C. Essay Topic (Max 300 words…please attach) “In your own words describe the automobile
industry’s future in terms of innovative energy ideas. Please explore in your essay at least three (3) energy
alternatives.
D. Acknowledgment
I certify that the information provided in my application is true and accurate to the best
of my knowledge.
___________________________________ _________________________________
Signature of the applicant (required) Date
It is the applicant's responsibility to ensure that one (1) PHOTO and five (5) copies of each document is
included in the application package. This includes: (a) two reference letters, (b) a transcript, (c) the
scholars’ application and (d) an essay postmarked no later than the deadline August 9, 2012. Incomplete
application package will not be reviewed. For more information contact lavonia@lavoniaperrymanpr.com
Please mail all materials to Rainbow PUSH Automotive Project, 4335 West Fort Street, Detroit, Michigan,

49209. Attention: Rainbow PUSH-GM Foundation2012 Scholars Program.
3/4/2012

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