XU Pre-Graduate Scholars Research Program

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XU Pre-Graduate Scholars Research Program
Louis Stokes - Louisiana Alliance for Minority Participation
APPLICATION FOR PARTICIPATION
PLEASE TYPE OR PRINT. Complete the entire application. You may attach a resume, but you must still complete
all questions; or your application will be deemed incomplete and may not be considered. Please fill out each box (don't
just indicate “See Resume.”) Applications with missing or invalid job numbers will not be considered for any position.
PERSONAL INFORMATION
Name (Last, First, Middle):
Gender:
M
Street Address:
F
City, State & Zip:
XU ID or Social Security
Number:
Home Phone:
XU Pre-Graduate
Scholars Research Program
LS-LAMP Research
Program
Cell Phone:
Local Phone:
SCHOOL INFORMATION
MAJOR:
Program Applying For:
Current GPA:
Classification:
M
Xavier e-mail address:
Other e-mail address:
F
Year Expected to
Graduate:
RESEARCH EXPERIENCE
Please provide information regarding the research experience you had during the Summer or previous Academic
year. If on-campus, provide your mentor’s name.
Have you participated in any of the programs listed below (please check all that apply and indicate why you are no
longer a participant)
MARC
RISE
PREM
MBRS
GAELA
RII C2
LA-SiGMA
ESSAY
Where do you see yourself in the next 5 years? Describe your academic, career, and professional goals and why you
should be considered to become a participant in this program.
AGREEMENT and SIGNATURE
PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION.
By submitting this application, I affirm that the facts set forth in it are true and complete. As an applicant, I authorize
the University and its agents to have access to my academic records as needed in the administration of this program
for statistical purposes and to use selected portions of that information in reports to supporting agencies.
Name (printed)
Signature
Date
THIS APPLICATION MUST BE RETURNED TO THE SEMEP OFFICE, NCF ROOM 244 OR YOU MAY E-MAILL YOUR
DOCUMENTS TO MS. HUNTER AT [email protected]
Science, Engineering, and Mathematics Educational Programs Office
Xavier University of Louisiana
NCF Science Addition Room 244
1 Drexel Drive – Box 146
New Orleans, Louisiana 70125
(504) 520-7646
(504) 520-7966
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