DRG Scholarship Application Form

Detroit Rubber Group, Inc.
https://account.rubber.org/detroitrubbergroup
Please return complete applications to Mr. Erik LaBelle erik.labelle@syensqo.com Submissions due August 1.
DRG Scholarship Application
Full
Name:
Applicant Information
Last First M.I.
DOB:
Address:
Street Address Apartment/Unit #
City State ZIP Code
Email:
DRG
Sponsor:
Phone:
DRG
Sponsor
Email:
Citizenship:
Education (High School for Incoming Freshmen, College for Incoming Sophomores)
School:
Address:
From: To: GPA:
ACT
Composite:
Date
Taken:
SAT
Composite:
Date
Taken:
Please attach official high school / college transcript and official ACT and/or SAT test results
References / Recommendations
Please list and attach two (2) letters of reference / recommendation:
Full
Name:
Affiliation:
Address:
Full
Name:
Affiliation:
Role/Relationship:
Email:
Phone:
Role/Relationship:
Email:
Address:
1
Phone:

Intended or
current
college(s)
In what field(s)
do you plan to
major?
Miscellaneous
Briefly describe
any
extracurricular
activities in which
you participated:
Briefly describe
your educational
and/or career
goals:
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to receipt of scholarship, I understand that false or misleading information in my application may
result in termination of scholarship.
Name:
Date
:
2