Undergraduate LSAMP 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 program:

New LSAMP Application Form

Initiated in 1993-1994, CSU-LSAMP is an alliance of the 23 campuses of the California State University (CSU) system which supports a coordinated and comprehensive system-wide approach to broadening participation in science, technology, engineering and mathematics (STEM) disciplines.

Each of the CSU campuses has a CSU-LSAMP program that offers an array of activities and services designed to improve retention and graduation of undergraduate students in STEM. In addition, CSU-LSAMP seeks to increase the number of CSU-LSAMP students who enter STEM graduate programs.

 To be eligible to participate in CSU-LSAMP, students must:

  • Be a U.S. Citizen or Permanent Resident.
  • Be enrolled at a participating campus in an undergraduate major in a STEM discipline or have expressed an interest in pursuing a STEM baccalaureate degree.
  • Be an individual who has faced or faces social, educational, or economic barriers to careers in STEM.  
  • Each CSU-LSAMP campus program may have additional eligibility requirements.  Please see the Campus Coordinator.

Please follow the instructions accompanying the New LSAMP Application Form exactly. Submit all required application components to the LSAMP office (ASCB 360) during the posted office hours. Please click the appropriate links below to obtain the instructions or application form.

LSAMP Program @ Cal State LA Information

New LSAMP Student Application Form for AY 2016-2017 

Continuing LSAMP Application Form

Applications are accepted year round, but to be eligible for any LSAMP components including Early Registration, a valid NEW or CONTINUING STUDENT application must be on file and approved for the year in question. Each year runs September 1 through August 31 (e.g., current year is September 1, 2016 through August 31, 2017.) Note: You may start filing out this application in July of the current year. It may take 7 days from the date that you submitted your application before it gets approved so plan ahead and submit as early as possible to be eligible for all components of LSAMP.

Since you already completed the new student LSAMP application form (in fall 2013 or later), you no longer need to fill one out again. Instead, just take the time to update the following information and respond to the new questions. Each year you remain an undergraduate student enrolled in a STEM (Science, Technology, Engineering, or Mathematics) major and continue to work on your first bachelor’s degree, we will request that you complete an updated information form. YOU MUST RESPOND TO QUESTIONS 1-17 in case you are eligible for financial incentives, EVEN IF YOU HAVE NOT MOVED! Use check list below and make sure you answer ALL questions! You may bring all of these completed items to the LSAMP office (ASC Wing B – Room 360) – do NOT submit it in parts but rather SUBMIT EVERYTHING AT ONE TIME. You should keep this cover page for your own records.

Continuing LSAMP Student Application Form for AY 2016-2017

Early Registration Form

The Early Registration Request deadline for Summer Quarter 2016 and Fall Semester, 2016 has already passed (April 8, 2016) as previously posted on the website.

The Early Registration Request deadline for Spring Semester, 2017 is Friday, September 30, 2016 by 12 Noon. Starting with Spring Semester, 2017 early registration requests, students must have completed 3 seminar evaluations before the Request deadline. Make sure that you have submitted the 3 seminar evaluations to the LSAMP office (ASCS 360) within an hour after each seminar has ended. Also you need to provide a copy of your Spring Quarter, 2016 grades and Summer Quarter, 2016 grades (if you enrolled in summer classes) and you must provide a copy of your Fall Semester, 2016 class list. These items should be submitted or emailed (LSAMP@calstatela.edu) to the LSAMP Office in addition to providing documentation of participation in at least one LSAMP activity during the prior academic term (spring or summer, 2016) with the early registration form located on the LSAMP website under the “Undergraduate Forms” tab before the deadline.


Because we are switching to the semester system, instead of the 2 evaluations per quarter, the LSAMP undergraduate program will require 3 evaluations per fall and spring semesters if you want Early Registration.

Normally if you want Early Registration for SUMMER TERM or FALL SEMESTER, you have to get your 3 seminar evaluations and other stuff to LSAMP Office (ASCB 360)  by the early April deadline.

Normally if you want Early Registration for SPRING SEMESTER, you have to get your 3 seminar evaluations and other stuff to LSAMP Office (ASCB 360) by the late September deadline.

These deadlines are expected to occur each year around the same time, so make sure you plan ahead if you want early registration for any semester.

Summary of Everything you must submit for Early Registration Requests:

  1. The Completed Early Registration Form located on the LSAMP website under the “Undergraduate Forms” tab – we may modify this form later this quarter if needed to reflect semester switch.
  2. The 3 seminar evaluations (which are due in the LSAMP Office – ASCB 360 one hour after the seminar ends).
  3. Documentation that you participated in one of the LSAMP-sponsored activities prior to the Early Registration Request Deadline for each term.
  4. Once we fully switch to semester system, you will need to submit a print out of your previous semester grades (for SPRING 2017 early registration requests, read the paragraph above the double line for what you will need to submit).
  5. Starting in FALL 2017, we will require that you have your IAP (individualized academic plan) approved online in GET (check with your major department or your College Advisement Center on how to do this if you are unfamiliar with the IAP). In fact the IAP will eventually save you time with your LSAMP NEW or CONTINUATION application. It will replace the Academic Plan page that requires faculty advisor. If you have an approved IAP, you will simply be able to log into your GET account, click on the IAP link and you will see the date that it was approved. We will need that page and we will need you to click on the green VIEW AS PDF link and print out a copy of your IAP. No additional signatures will be needed for the academic plan.

 Early Registration Form

LSAMP Student Travel Request Form

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 funding. If your travel request is approved, you must provide the LSAMP Office the following information within 5 days of approval notification: (a) Final Destination for trip; (b) Method of Travel (e.g., public air; personal vehicle); (c) License Plate number if you are driving your private vehicle; (d) Date and Time of Departure from your home address; (e) Date and Time of Arrival at the Conference Location; (f) Date and Time you plan to Depart Conference Location; (g) Date and Time you plan to arrive home; (h) if flying, you must indicate whether or not you want LSAMP to prepaid your airfare – please complete LSAMP Student Airfare Pre-Pay form below; (i) if trip is overnight and out of town, you must indicate whether or not you want LSAMP to prepaid your hotel – more paperwork and more information required; (j) if there is a registration fee and it is more than $100, you must indicate whether or not you want LSAMP to prepaid – more paperwork and more information required; (k) if presenting oral or poster presentation, you must email LSAMP a copy of your abstract before any costs are covered by LSAMP. Once you have provided the required information, 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. 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 below to access the LSAMP Student Travel Request Form.

LSAMP Student Travel Request Form

LSAMP Student Airfare Pre-Pay Form

Seminar Evaluation Form

This form should be completed for each speaker and submitted to the LSAMP Office within 2 hours after the seminar – only handwritten copies will be accepted. Therefore, print out a few copies of this form to be handwritten legibly during the seminar. Please click the link below to access the Seminar Evaluation Form.

Seminar Evaluation Form

Responsible Conduct Research Training

All LSAMP students engaged in research and receiving a stipend for research activities through NSF funding must complete this training activity required by NSF before any stipend check can be released to you.  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 on Responsible Conduct of Research. More instructions on what and when to print out this document appear on pages that follow. The training occurs through a web link to a site at Sacramento State. Please click the link below to access the Responsible Conduct Research Training Instructions.

Responsible Conduct Research Training Instructions

LSAMP Undergraduate Acknowledgement Statement

Whenever CSU-LSAMP @ CSULA 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 LSAMP@calstatela.edu

LSAMP Undergraduate Acknowledgement Statement

CSU-LSAMP is supported by the National Science Foundation under Grant # HRD-1302873 and the CSU Office of the Chancellor.