New Application | Cal State LA

Last Name (Surname)

First Name

Middle Name

Gender

Male

Female

Non-Binary

Mailing Address

Street Number and Name

City

State

Zip Code

Telephone Number

Email (Preferred)

Date of Birth (Month/Day/Year)

Place of Birth (City, State & Country)

Citizenship

U.S. Citizen

Permanent Resident. Please enter permanent resident registration #:

Ethnicity (for statistical purposes only):

Hispanic or Latino (A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race)

Not Hispanic or Latino

Decline to State

Race (for statistical purposes only - choose all that apply):

Black or African American - A person having origins in any of the black racial groups in Africa

Alaska Native - A person having origins in any of the original peoples of Alaska, including Eskimos or Aleuts

Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, Polynesia, Micronesia, or other Pacific Islands

Asian - A person having origins in any of the original peoples of East Asia, Southeast Asia, or the Indian subcontinent. This area includes, for example, China, India, Indonesia, Japan, Korea, and Vietnam

American Indian - A person having origins in any of the original peoples of North America and maintaining cultural identification through tribal affiliation or community recognition.

White - A person having origins in any of the original peoples of Europe, North Africa, or the Middle East

Decline to State

Other:

What is your mother's level of education?

No College

Some College

College Graduate

Graduate School

What is your father's level of education?

No College

Some College

College Graduate

Graduate School

Disability Status

Yes

Decline to State

Disability Status (again, for statistical purposes only): Please check “yes” if any of the disabilities listed below the check box apply to you. Otherwise, check no or decline to state. · Deaf or serious difficulty hearing · Blind or serious difficulty seeing even when wearing glasses · Serious difficulty walking or climbing stairs · Other serious disabilities related to a physical, mental, or emotional condition

Are you a veteran of the U.S. Armed Forces?

Yes

Decline to State

As an undergraduate, are you eligible for need-based financial aid?

Yes

Are you treated as an independent student for financial aid purposes?

Yes

What is your Personal yearly income?

Less than $10,000

$10,001 - $20,000

$20,001 - $30,000

More than $30,000

What is your Family's yearly income?

Less than $10,000

$10,001 - $20,000

$20,001 - $30,000

More than $30,000

Major

Minor (if any)

Class Level:

Freshman

Sophomore

Junior

Senior

Total Number of Units Completed (indicate semesters or quarters):

Total Number of Major Units Completed (indicate semesters or quarters):

Cumulative GPA (Do not round up - 3 decimal places available in GET):

Major GPA (Do not round up - 3 decimal places available in GET):

TERM & YEAR you expect to receive your Cal State LA Undergraduate Degree:

Anticipated Undergraduate Degree

Bachelor of Arts- BA

Bachelor of Science - BS

Transfer Student

Did you transfer from a California Community College (2-year school)?

Yes

If Yes, which college?

If Yes, how many units did you complete prior to transferring?

Did you complete an Associate's Degree?

Yes

Cal State LA CIN

Cal State LA Email Address

First TERM and YEAR you enrolled in classes at Cal State LA:

Have you completed all lower division MATH requirements (1000 and 2000-level courses) required for your major?

Yes

Have you completed all lower division ENGINEERING and/or SCIENCE requirements (1000 and 2000-level courses) required for your major?

Yes

Are you eligible to receive financial aid?

Yes

Are you receiving financial aid for this academic year?

Yes

If you are eligible to receive financial aid but am NOT receiving financial aid, please explain why.

What is your career goal (what do you want to do after you graduate)?

Are you currently doing any research?

Yes

Do you currently participate in an internship?

Yes

Have you participated in research before?

Yes

Have you participated in an internship before?

Yes

Are you interested in obtaining a graduate degree at the Masters level after you graduate?

Yes

May be

Are you interested in obtaining a graduate degree at the PhD level after you graduate?

Yes

May be

Are you interested in teaching at any educational level?

Yes

May be

Are you interested in obtaining a professional degree (e.g., MD, OD, DDS, D Pharm, etc.)?

Yes

May be

Do you plan to get a full-time job in STEM (science, technology, engineering, mathematics) as soon as you complete your undergraduate degree?

Yes

May be

Do you currently have a part-time or full-time job in STEM area?

Yes

Please prepare the following documents according to the instructions and check off that you have done so. You must email all documents to [email protected] including the financial aid forms, even if you do not receive financial aid. Acceptable file types: pdf, png, jpeg, tiff, jpg. 256 MB limit.

Academic Year 2023-2024 form

Instructions- read carefully: https://www.calstatela.edu/lsamp/instructions-academic-year-2023-204-and-financial-aid-2023-2024-forms

Financial Aid Summary 2023-2024 form

Instructions- read carefully: https://www.calstatela.edu/lsamp/instructions-academic-year-2023-204-and-financial-aid-2023-2024-forms

Academic Degree Planner form

Instructions- read carefully: https://www.calstatela.edu/lsamp/instructions-obtain-academic-degree-planner

Self-Portrait

Professional style headshot

Before you submit your online application, please confirm that you have emailed the 4 files to [email protected].

Academic Year 2023-2024 form

Financial Aid Summary form

Academic Degree Planner

Self-Portrait

Your LSAMP application will only be reviewed when these files have been received at [email protected].

Please read the statement below and sign where indicated:

The information I have submitted in my California State University LSAMP Application is true and accurate to the best of my knowledge. I understand that to track the progress of the CSU-LSAMP students and to evaluate program effectiveness, CSU-LSAMP requires access to student information. The CSU-LSAMP program is required to report individual student data to the National Science Foundation including social security number, ethnicity, GPA, and enrollment status. This information is also used to study student transfer, retention, progression, and graduation. Photographs and research abstracts may also be obtained for use by the CSU-LSAMP program in program dissemination materials such as websites, newsletters, and reports. The student data are collected by the CSU-LSAMP Statewide Office at California State University, Sacramento and each of the 23 affiliated Alliance CSU campuses. I authorize release and use of personal information, as described above, to the CSU-LSAMP program. I understand that this information is to be used solely for evaluating the impact and effectiveness of the CSU-LSAMP program and that individual student data will not be released to parties other than those directly involved with the program.

Furthermore, I understand that if I am receiving financial aid from Cal State LA, and if I have no unmet need but have loans that I have accepted as part of my financial aid packet, any funds that I may receive from the LSAMP program may result in a reduction in my loans received from Financial Aid. I understand that loans must be paid back and receiving awards from this program will result in less money I will have to pay back (as long as the information that I have provided is accurate and approved by the Office of Financial Aid). Alternatively, if I am receiving financial aid from Cal State LA, and I have no unmet need and no loans as part of my financial aid package, LSAMP MAY NOT be able to provide me with any stipend for which I may be eligible. I understand that the Financial Aid Office determines whether or not I am eligible for a stipend– LSAMP does NOT control this decision. If I fall into this category, I may be eligible for other incentives.

I have read and understand all of the statements above.

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