LSAMP-BD Cohort XI Forms


All forms are PDF format. In order to open and edit these documents, you have have Adobe Reader installed on your computer. You can download this free program by clicking here.

The following are common forms used by the LSAMP-BD program:

LSAMP-BD Cohort XI AY 2015-2016 Calendar

Please refer to this document for all important meeting dates and deadlnes for AY 2015-2016. In addition the calendar contains dates for conferences you may be interested in attending. Please click the link below to downlad the LSAMP-BD Cohort XI AY 2014-2015 Calendar.

LSAMP-BD Cohort XI AY 2015-2016 Calendar


Responsible Conduct Research Training

All LSAMP-BD Fellows must complete the two courses listed under this training activity required by NSF before any stipend check can be released to you.  Therefore, this means on or before September 26, 2014 that you must submit to Dr. Jefferson a copy of the Main Page (which will have your name printed on the upper right corner) that shows you have passed and completed the training for both courses on Responsible Conduct of Research. Detailed instructions on what and when to print out this document appear on pages attached to the link below. The training occurs through a web link to a site at Sacramento State University, the lead campus for the CSU-LSAMP and LSAMP-BD programs.

Responsible Conduct of Research Instructions

Two-Year Academic Plan

The Two-Year Academic Plan is designed to ensure that you are aware of all requirements to be completed for your MS STEM degree, and that you have met with both your faculty research mentor and your departmental graduate advisor to carefully plan your coursework so that you can graduate with an MS STEM degree within the two-year period. When changes occur, updated electronic submissions to Dr. Jefferson ( and Dr. Yamazaki ( are due. Simply download your major template from the link below, open with Adobe Reader, type in your name and course info using the color code, and email to us.

Two-Year Academic Plan Template

LSAMP-BD Seminar Evaluation Form

Each quarter you must complete 8 seminar evaluation forms (please refer to your contract as to the types of seminars permitted). The evaluation forms should be downloaded and typed using Adobe Reader (or other software) to type information directly onto the form in the link below. These evaluations must be emailed to Dr. Jefferson ( and Dr. Yamazaki ( within 7 days of the seminar. See the attached form for instructions for what to put in the subject line and how to specifically name the file before emailing it to us.

LSAMP-BD Seminar Evaluation Form

LSAMP-BD Sample Contract

This link below contains the sample contract that was discussed at the LSAMP-BD Orientation Retreat. Each of you received your personalized contract that must be signed by your faculty research mentor and you, and then submitted no later than the first monthly meeting of year one (for BD-XII Fellows, this date is September 24, 2015).

LSAMP-BD Sample Contract

Thesis Committee Form

Most STEM departments require a thesis committee of at least 3 faculty members, two in addition to your faculty research mentor (Research Director). In consultation with your Research Director, complete the thesis committee form and submit electronically to Dr. Jefferson ( and Dr. Yamazaki ( Please see instructions on the form for email subject line and filename format. Due to the collaborative nature of STEM research, you are strongly encouraged to have at least one faculty member outside your major department. 

Thesis Committee Form

CV Assignment

In your LSAMP-BD contract under Curriculum Vitae, you have been given an assignment to take the current version of your CV to one of the two Writing Centers [either MORE Writing Center in BIOS 161 or the University Writing Center in JFK Library Palmer Wing 1039A] and have it evaluated . Both of these places require appointments to do this. We expect you to submit both the Writing Center evaluation and an updated CV to us BEFORE your fall, 2015 quarterly advisement session (refer to calendar for details). We have attached a document here to help you understand the difference between a CV and resume as well as some suggestions on what should be included in an academic professional CV.

CV Guidelines


Quarterly Research Progress Report

The Research Progress Report is completed at the end of each quarter. You will discuss specific components of your MS thesis progress and plans, publications, presentations, submitted papers for publication. Each quarter you will simply add to the information that you provided in the previous quarter – no prior information should be removed from this form. Please read and follow all instructions on the form. Refer to your annual calendar for the specific due dates for this quarterly research progress report. When you electronically deliver the report to us by the due date, save the file with filename in the following format:

LastNameFirstNameResearchProgressReport, where you substitute your last and first name in file name. The Subject Line of email message should be Research Progress Report.

Research Progress Report

Travel Request & Approval Procedures

This form should be completed for those that want to attend or present at a professional meeting. This form must be typed and must be submitted at least 45 days prior to departure date to guarantee that it is funded. Once you have provided the required form, you will need to sign a UAS Vendor Form and the UAS Travel Approval Form at least 30 days prior to your departure date. These forms will be completed by LSAMP staff prior to the start of the 30-day day period. Within 10 days of returning from the conference, you must provide a copy of the Conference Detailed Agenda showing meals covered by the registration fee, all receipts, proof of payment if paid by credit card (i.e., credit card statement). LSAMP staff will complete the Travel Claim Form within 5 working days and contact you to come in and sign the travel claim. If deadlines are missed, reimbursement is not likely. Please click the link to access the LSAMP-BD Student Travel Request Form. A maximum of $1,000 per year to cover your travel expenses will be provided by the LSAMP-BD grant assuming your faculty research mentor does not exceed $1,000 for all costs associated with your MS research supply budget. If we are paying out of state tuition for you, there is no travel or research supply budget. We strongly urge everyone to apply for other sources of travel funds.

Travel Request & Approval Procedures

Research Supply Procedures and Form

Each CA resident, LSAMP-BD student has been allocated $1,000 for MS thesis research supplies. This must be discussed with your faculty research mentor and must be approved by your faculty research mentor (see instructions on how the approval is done). Please read and follow all instructions provided in the link: Research Supply Procedures. Then accurately complete the form (which must be typed) in the link: Research Supply Purchase Order Form – Year One only. If your faculty research mentor plans to use a purchase order to order supplies, the last date each year that a PO can be submitted is July 1, 2015 for Year One funds or July 1, 2016 for Year Two funds. The POs must be emailed as attachments using your standard BD student filename system (LastNameFirstNamePO) where the BD student’s first and last name is provided. Email the forms to lsamp@calstatela.eduwith the  SUBJECT LINE – PO for BD student’s Name.

If research supplies are purchased directly with you or your research advisor paying for them first, different paperwork is required. Those forms will be completed by the LSAMP Office staff. Within 10 days of the purchased items, please bring the following information to the LSAMP Office (ASCB – Room 360): (a) complete name, mailing address, phone number, and email address of the person who made the purchase; (b) itemized original receipt from company that items were purchased from with proof of payment (cancelled check or credit card statement if not paid with cash); and (c) this individual may need to come to the LSAMP Office to sign a form; if required, the LSAMP staff will call the individual at phone number provided. If you choose to spend your funds this way, all purchases must be made on or before July 31st of each year.

Please communicate all of this information, the instructions/procedures, and the form to your faculty research mentor. It is your responsibility that they do not exceed your total research supply allocation.


Research Supplies and Procedures - Year One Funds

UAS Purchase Order Form - Year One Funds


Research Supplies and Procedures - Year Two Funds

UAS Purchase Order Form - Year Two Funds

Overnight Parking on Campus Form

In case you need to park your vehicle overnight on campus because you have an experiment that takes more than 24 hours to complete or because you are traveling via other means of transportation as part of a group that takes you out of town for more than 24 hours, complete the linked form. Take this form to the Office of Public Safety (campus police station).

Overnight Parking on Campus Form

Proper Acknowledgement of LSAMP-BD for Cohort XI

Whenever the LSAMP-BD Cohort XI program provides travel support, stipend support, or research supply support for work that you submit for presentation at conferences or publications in journals, etc. you need to properly acknowledge such support when submitting abstracts, publications, and poster or oral presentations. The link below states the wording that should be used in such acknowledgements. Also be certain to submit an electronic copy of abstracts and/or publications to

Proper Acknowledgement of LSAMP-BD Cohort XI


The funding for LSAMP-BD Cohort XI and XII is provided by the National Science Foundation under Grant # HRD-1363399.