2013 Michigan Louis Stokes
AllianceState
for Minority
Participation (MI-LSAMP)
Michigan
University
Engineering
andPrograms
Science Summer
Academy
Pre-First Year
Application
Sponsored by the National
Science Foundation
Directions:
Please read carefully and complete all items. Incomplete information may delay the processing of your application.
The review of applications will begin immediately, however applications will be accepted until all openings are filled.
PERSONAL INFORMATION - Please Print or Type
Name:
Last
First
Middle
Home Address:
City:
State:
(mm/dd/yyyy)
Date of Birth:
Zip:
Gender:
Home No.: ( )
Cellular No.: ( )
M
F
Email Address:
Ethnicity:
African American
American Indian
Caucasian
Asian
Hispanic
Other (specify):
Parent(s) / Guardian(s) Name:
Home / Cellular / Work Telephone Number(s):
ACADEMIC / EXTRACURRICULAR – Please Print or Type
Major academic interests:
Career interests:
Educational goals:
Awards/honors:
Extracurricular activities:
2013 Michigan Louis Stokes
AllianceState
for Minority
Participation (MI-LSAMP)
Michigan
University
Engineering
andPrograms
Science Summer
Academy
Pre-First Year
Application
Sponsored by the National
Science Foundation
List other pre-engineering, math, science, science projects/experiments or special programs in which you have
participated.
Program
Sponsoring Institution
Dates
Please describe any previous work or volunteer experience, or organizational membership. (If needed you may
attach an additional sheet.)
**** Please include a copy of your high school transcript ****
To participate in the Engineering and Science Summer Academy, you have committed to attend Michigan State
University starting the Fall 2016 term.
Please indicate your T-shirt size:
Student Signature:
Date:
Parent/Guardian Signature:
Date:
2013 Michigan Louis Stokes
AllianceState
for Minority
Participation (MI-LSAMP)
Michigan
University
Engineering
andPrograms
Science Summer
Academy
Pre-First Year
Application
Sponsored by the National
Science Foundation
PROGRAM DATES:
June 19, 2016 – August 6, 2016
All application materials should be returned to:
Sharita Williamson
Academic Advisor
Lyman Briggs College
Michigan State University
East Holmes Hall, Room 35
919 E. Shaw Lane
East Lansing, MI 48825-3804
DEADLINE: Rolling Admissions. Please submit your application as soon as
possible.