To be eligible for 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 in interest in pursuing a STEM baccalaureate degree;

        • Be an individual who has faced or faces social, educational, or economic barriers to careers in STEM

Full Name*:

Telephone(s)*: ( ) - Optional: ( ) -

Local Address*:


Home Address*:


E-mail*:

Ethnicity*: Select one Latino African American American Indian Alaskan Native Hawaiian Native Pacific Islander Other

Date of Birth*: / /

Gender*: Select One Male Female

Current School*:

College you will attend, Fall 2009*:

Major*:

Minor:

Who told you about LSAMP? (Optional):

Have you taken Trigonometry?*: Select One Yes No

At what school?*:

Month/Year Completed*:

Grade, or best estimate*:

What is your current or most recent math course?

Course*:

School*:

Month/Year Completed*:

ELM Score:

If you are not a local resident,
are you interested in on-campus housing? Select Yes No

Please provide a brief description of your reasons for wanting to participate in LSAMP.
Please include why you think mathematics is important to your major or career objective.*:

Before you submit, go back and make sure ALL required (*) fields are filled in.

Do not forget that a copy of your high school transcripts are needed along with this application.

For security, please type Lori's last name in the box: