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Emergency Notification

Louis Stokes Alliance for Minority Participation

New Application

California State University Louis Stokes Alliance for Minority Participation Program (CSU-LSAMP) APPLICATION
CAMPUS: Los Angeles YEAR: 2021-2022

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.

Instructions for CSU-LSAMP @ Cal State LA Applicants (Please read to avoid return of your application)

1. To find your MAJOR GPA in GET (which is needed on page 3), in the pull down menu of Student Service Center, select Academic Requirements. It appears at the bottom of your Academic Requirements screen under the header “Major Units/GPA Requirements.” Click on this heading to expand and show your MAJOR GPA.

2. Section V, please follow the instructions in section V carefully and attach the two required documents to your application regardless of whether or not you receive financial aid.

3. Section VI, please follow the instructions in Section VI carefully and attach the correct Academic Plan.

4. Submit all required components electronically.

5. You may call LSAMP at (323) 343-2095 or email [email protected]

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 #:

Citizenship 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:

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

Please indicate your parents' level of education *

	No College	Some College	College Graduate	Graduate School	N/A
Mother *	Mother - No College	Mother - Some College	Mother - College Graduate	Mother - Graduate School	Mother - N/A
Father *	Father - No College	Father - Some College	Father - College Graduate	Father - Graduate School	Father - N/A

Disability Status *

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

Yes

Decline to State

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)? *

Section V : Academic Year 20-21 form (PLEASE READ AND DO EVEN IF YOU DO NOT RECEIVE FINANCIAL AID) *

Instruction: https://documentcloud.adobe.com/link/track?uri=urn:aaid:scds:US:1c3a07d0-bebc-4455-9a2f-81f9d5d2379a
Files must be less than 2 MB.
Allowed file types: pdf.

Section V : Financial Aid Summary 20-21 form *

Files must be less than 2 MB.
Allowed file types: jpg jpeg png pdf.

Section VI : Academic Planner *

Instruction: https://documentcloud.adobe.com/link/track?uri=urn:aaid:scds:US:2478708d-a0d3-4347-9573-a362f753cdb8
Files must be less than 2 MB.
Allowed file types: pdf.

Please submit a self portrait (From the waist up and face needs to be visible.) *

Files must be less than 2 MB.
Allowed file types: jpg jpeg png.

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. I have read and understand all of the statements above.