General Motors – Technical Education Program (GMTEP)

This form should only be completed by approved GMTEP students, pursuing USC Systems Architecting and Engineering courses as part of their approved Master of Science in Engineering (MSE) program.

Limited Status Enrollment

Limited students can enroll in a maximum of 12 units under the limited status enrollment category. If you are completing your 12th unit as a limited student, you will not be eligible to take another USC course until you have been formally admitted to a USC degree or certificate program.

Personal Information

USC Student ID (if known, former USC student):

Email (provide GM email address):

First Name:

Last Name:

Home Phone:

Work Phone:

Birthdate:

Undergraduate Education

Undergraduate Degree Completed:

Major:

University:

City:

Country:

GPA (4.0 Scale)/ Minimum Average:

Year Awarded:

Student Location During Program

GMTEP students located in the United States will have the option to (1) utilize a DEN@Viterbi provided proctor at a local proctoring center, or (2) submit the corporate proctor form so a General Motors designated proctor can be reviewed for USC approval.

Students located outside the United States must identify a corporate proctor, and submit the corporate proctor form for approval . Proctor information, including guidelines and forms, will be sent to students after they register for courses every academic semester.

Work Address (Required)

Address:

City:

State:

Zip:

Country:

Demographic Information

Citizenship:

Gender:

Ethnicity: Former Name (If Applicable):

GMTEP Company Information

Current Position / Title in Company: