Peach State Louis Stroke Alliance Minority Participation (LSAMP) Program

Application

Thank you for your interest in becoming a part of Kennesaw State University Science, Technology, Engineering and Mathematics Scholars Program. We are dedicated to ensuring the success of fellow undergraduate students and high school students pursuing a career in a STEM field. The LSAMP program is an extra-curricular activity for KSU students and participants may receive a stipend from National Science Foundation/Louis Stroke Alliance Minority Participant Program, and NASA every semester for participating. Participating in the LSAMP program and any other program or associations at the College of Science and Mathematics and at Kennesaw State University, will give you the additional credential that today’s graduate schools are looking for in an applicant.

Please fill out the attached application form and include your resume, current semester course schedule, and a copy of your KSU transcripts. Once you have completed your application, please submit it to Dr. PN Achar, LSAMP Office at Science Building Room #300.

If you have any questions, please contact:

NSF/LSAMP Student Coordinators

Dr. PremilaAchar,

LSAMP Office at Science Building Room #300.

/ LSAMP Scholars Program
Application /

We appreciate your interest in the Kennesaw State University Peach State LSAMP Program. The goal of the NSF/LSAMP Program is to assist underrepresented minority students** in achieving academic excellence through research experiences. This program rewards the most diligent students for the work they put into their academic career, and helps to support them in their ambitions to be highly successful in Science, Technology, Engineering, and/or Math. The following folder is your opportunity to show the work you already do, so that we (as a program) can reward and support you! There are three areas in which LSAMP Scholars focus on: Academics, Outreach and Research. Every fall and spring semester there will be ten weeks where everyone will have the opportunity to show their outstanding participation and progress in the three core areas, via this folder. There is an extra opportunity for scholars to participate in outreach for a short time during the summer. All events and activities are voluntary and are up to your discretion, but a set number of members who display outstanding participation will be rewarded for theirenthusiasm as a member and their dedication to this program accordingly.

Best Wishes!

KSU NSF/LSAMP Director: Dr. PN Achar

Co-Director: Dr. M. Griffin

Application materials:

Completed KSU LSAMP Scholars Program Application
Official Kennesaw State University Transcript
Copy of your resume
Copy of current Semester Course Schedule

/ LSAMP Scholars Program
Application /

PERSONAL INFORMATION

First Name: ______Middle Initial: _____Last Name: ______

KSU ID:______Intended Major:______Cum. GPA: ______

Year: ______E-Mail:______Phone: ______

Home Address: ______

Mailing Address (If different from home address): ______

______

Expected Graduation Date (Semester/Year): ______

Have you ever convicted of anything other than a minor traffic violation? ______

If so, explain?

ACADEMICS

What are your career goals?

Circle three of the following subjects which you feel most knowledgeable about:

CALCULUS ALGEBRA BIOLOGY CHEMISTRY TECHNOLOGY PHYSICS BIOCHEMISTRY

Which, if any, science courses have you taken as an undergraduate and respective letter grades received?

/ LSAMP Scholars Program
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GOALS: Which category would you like to focus on this semester?

(Please check one)

______Academic Enrichment ______Research ______Outreach

WORK HISTORY

Have you held any jobs in the past 2 years?

Are you currently employed?

List your last three employers starting with your most recent one. If currently employed, write “still employed” in the Years of Employment section:

Name of Employer / Telephone / Supervisor / Years of Employment

FACULTY RECOMMENDATIONS

You must provide two faculty recommendations on this section.

Name of Applicant:

Signature of Applicant: ______Date:______

FIRST FACULTY RECOMMENDATION:

This program is designed for students who achieve more than what is expected of them. It is imperative for the success of this program that we select the most responsible, professional, and hard-working individuals for this program. The success of their co-workers and high school students depends on each individual’s work ethic, academic achievement, responsibility, and commitment.

Would you recommend the person whose name appears on this application for a position with Kennesaw State University’s LSAMP Scholars Program? If so, please fill out the portion below:

Name: ______Department: ______

Signature: ______Date: ______

SECOND FACULTY RECOMMENDATION:

Would you recommend the person whose name appears on this application for a position with Kennesaw State University’s STEM Scholars Program? If so, please fill out the bottom portion below:

Name: ______Department: ______

Signature: ______Date: ______

/ LSAMP Scholars Program
Application /

PERSONAL STATEMENT

Write a brief two paragraph statement below as to why you would like to participate in the KSU STEM Scholars Program and why you feel you have the best qualifications over other applicants.

DECLARATION

I, ______, confirm that the information above is accurate to the best of my knowledge. I also confirm that the faculty recommendations are for myself. I realize that if accepted, I will be contacted via the e-mail address that I have provided above to notify me as to whether I have been accepted or not. I acknowledge that I will have no more than 2 business days to accept my position before it is given to another applicant.

Signature:______Date:______

Application Due in 2nd Week of each Semester