LSAMP Application

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This is the application form for participation in LSAMP--the Louis Stokes Alliance for Minority Participation. LSAMP provides academic and finacial support for underrepresented minorities in the STEM sciences who are seeking degrees
beyond a B.S (Bachelor's in Science). Be sure to answer all the questions to the best of your knowledge. Once you submit the form, you will not be able to edit the application.

First Name

Last Name

OCC Student ID #

Birthday

OCC Email

Phone Number

e.g. (999) 999-9999

Gender Identity

Female

Male

Transgender

Nonbinary

Perfer not to answer

Address:

City:

State:

Zip:

Citizenship

U.S Citizen

Permanent Resident

Race/Ethnicity

What is your College GPA or High School GPA?

Major

Have you or are you currently a participant in LSAMP?

Have you or are you currently a participant in CSTEP?

Would you like to know more about the CSTEP program?

Yes

What is your current class level?

Expected Graduation Date (m/yr)

Briefly, describe your educational and career goals after you graduate from OCC (550 characters max).

By checking this box, you agree to participate in LSAMP activities at least twice a semester.

By checking this box, you give permission for LSAMP to take and use photos of you for use on marketing materials, program information and newsletters, and similar materials.

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