Kansas Louis Stokes Alliance for Minority Participation
Research Immersion: Pathways to STEM (RiPS)
Program Dates: May 31, 2016 – July 27, 2016
APPLICATION CHECKLIST
PLEASE MAKE SURE YOU COMPLETE EVERYTHING LISTED ON THIS CHECKLIST.
INCOMPLETE APPLICATIONS WILL NOT BE REVIEWED.
_____ 1. Complete the Student Information Form
_____ 2. Include two (2) completed Faculty Recommendation forms. Each recommendation must be from a college
faculty member or instructor of a STEM course (ex. biology, chemistry, math, physics etc.) you are currently enrolled in
or have already completed. Please select someone who can accurately evaluate your abilities. Do not ask family
members, friends, community members, or a high school teacher to write a recommendation for you. Failure to provide
two recommendations will result in an incomplete application. If your recommenders want to send their
recommendations directly to our office, please see the address below.
_____ 3. Complete the Personal Statement. Essays should be no longer than one page single-spaced. Please include all
topics mentioned in the directions and remember to have your essays reviewed for grammar and spelling.
_____ 4. Provide a copy of your most current transcript. If you have attended multiple schools, please provide copies
from each institution. Unofficial transcripts may be submitted with your application, but please note that under certain
circumstances we may ask for official transcripts.
_____ 5. Mail completed applications to:
KS-LSAMP Research Immersion Program
c/o – Brenee King
125 Seaton Hall
Kansas State University
Manhattan, KS 66506
OR
Email all portions of the application (PDF or Word files) to lsamp@ksu.edu. To ensure all portions of the application are
received, please send the application in one email (may include multiple attachments). Letters of reference may be emailed
separately.
APPLICATION DEADLINE: February 29, 2016
(Mailed applications must be postmarked by this date)
NOTE: Make sure the application has your signature on the student information form. An application missing any of
the components listed above will be considered incomplete and will not be reviewed.
A selection committee will make the final decision regarding RiPS 2016 participants and applicants will be notified of
the committee’s decision by mid March 2016. Accepted students will need to confirm their participation in the program
by early April 2016. If you have any questions regarding your application packet, please contact Brenee King at (785)
532-6054 or contact lsamp@ksu.edu
STUDENT INFORMATION FORM
2016 Research Immersion: Pathways to STEM (RiPS) Application
PLEASE WRITE CLEARLY
Name: ________________________________________________________________
Date of Birth: _____________________________
Age: ________________
U.S. Citizen: ________ YES _______ NO
Home address: _____________________________________________________________________________________________
City/State: _______________________________________________ Zip: _____________________________________________
Home Phone: (___________) _____________________________ Cell phone: (___________) _____________________________
Email: ___________________________________________________________________________________________________
Current/intended major at K-State:____________________________________________________________
Current College/University: _________________________________________________________________
Areas of research interest
Using the list of programs below, please list your interests:
1)____________________________ 2) _____________________________ 3) _______________________________
Ag Economics
Agricultural Engineering
Agronomy
Anatomy & Physiology
Animal Science
Architectural Engineering
Biochemistry
Biological Engineering
Biology
Chemical Engineering
Chemistry
Civil Engineering
Computer Engineering
Computer Science
Construction Science
Dietetics
Electrical Engineering
Food Science
Geology
Grain Science
Horticulture
Human Nutrition
Industrial Engineering
Kinesiology
Math
Mechanical Engineering
Physics
Current grade point average: ___________ Expected graduation date from current institution (mo/yr): _____________
ACT scores: Composite score ____ Please provide the individual scores for that test (practice or official)
Eng ______ Math ______ Reading ______ Science ______ Comb Eng/Writing ______
If accepted, do you understand you will have commitments related to the RiPS program between May 31, 2016 and July 27, 2016?
Yes: ______ Not clear: _______________
I understand that if accepted into RiPS, I will be part of Kansas Louis Stokes Alliance for Minority Participation, which is an
academic program that will track and support my academic progress beyond the summer and throughout my college career.
Yes: ________ Not clear: _______
I HEREBY AFFIRM THAT ALL INFORMATION CONTAINED IN THIS APPLICATION IS TRUE, TO THE BEST OF
MY KNOWLEDGE
APPLICANT SIGNATURE ______________________________________________________________
FACULTY RECOMMENDATION
2016 Research Immersion: Pathways to STEM (RiPS) Application
May 31, 2016 – July 27, 2016
The Research Immersion: Pathways to STEM (RiPS) at Kansas State University is an 8-week program that offers summer
academic and professional preparation for community college students, community college transfer students and current Kansas
State University students entering science, technology, engineering or math (STEM) fields. The RiPS program looks for students
who genuinely possess the potential to prepare for and succeed in a college education in STEM fields. Your accurate and candid
appraisal of the applicant will be closely examined during the student selection process. Additional pages may be included. A
Microsoft Word version of this file may be retrieved at http://www.k-state.edu/lsamp/summer_programs
Applicant Name: ___________________________________________________________________________________________
LAST
FIRST
MIDDLE
Recommender Name: _______________________________________________________________________________________
LAST
FIRST
Recommender’s current institution/position: _____________________________________________________________________
1. How long and under what circumstances have you known the applicant?
2. Has the applicant discussed his/her career goals with you? If so, please describe these goals.
3. Please discuss the applicant’s motivation for success?
4. Please discuss the applicant's reasoning skills?
5. Please give examples of the applicant's ability to communicate?
6. Does the applicant exhibit classroom leadership qualities?
7. Does the applicant work well in groups?
8. In your opinion, would the applicant effectively meet the demands of a rigorous summer academic program which
includes a mentored independent-research experience?
______ Strongly recommend this student for participation
______ Recommend this student for participation
______ Recommend this student with reservations
______ Do not recommend this student
9. We would appreciate any additional comments concerning the applicant’s capacity for future college work and his/her
potential for becoming a responsible and successful college student in the fields of science, technology, engineering or
math.
_______________________________________________________________________________________________________
Signature / Class Taught
Date
Completed recommendations may be: 1) returned to the student in a sealed envelope to submit with their application, 2)
sent directly to: KS-LSAMP Research Immersion Program c/o – Brenee King, Kansas State University, 125 Seaton Hall,
Manhattan, KS 66506 or 3) emailed as a PDF or Word file directly to lsamp@ksu.edu
More information about KS-LSAMP can be found at: www.k-state.edu/lsamp
FACULTY RECOMMENDATION
2016 Research Immersion: Pathways to STEM (RiPS) Application
May 31, 2016 – July 27, 2016
The Research Immersion: Pathways to STEM (RiPS) at Kansas State University is an 8-week program that offers summer
academic and professional preparation for community college students, community college transfer students and current Kansas
State University students entering science, technology, engineering or math (STEM) fields. The RiPS program looks for students
who genuinely possess the potential to prepare for and succeed in a college education in STEM fields. Your accurate and candid
appraisal of the applicant will be closely examined during the student selection process. Additional pages may be included. A
Microsoft Word version of this file may be retrieved at http://www.k-state.edu/lsamp/summer_programs
Applicant Name: ___________________________________________________________________________________________
LAST
FIRST
MIDDLE
Recommender Name: _______________________________________________________________________________________
LAST
FIRST
Recommender’s current institution/position: _____________________________________________________________________
10. How long and under what circumstances have you known the applicant?
11. Has the applicant discussed his/her career goals with you? If so, please describe these goals.
12. Please discuss the applicant’s motivation for success?
13. Please discuss the applicant's reasoning skills?
14. Please give examples of the applicant's ability to communicate?
15. Does the applicant exhibit classroom leadership qualities?
16. Does the applicant work well in groups?
17. In your opinion, would the applicant effectively meet the demands of a rigorous summer academic program which
includes a mentored independent-research experience?
______ Strongly recommend this student for participation
______ Recommend this student for participation
______ Recommend this student with reservations
______ Do not recommend this student
18. We would appreciate any additional comments concerning the applicant’s capacity for future college work and his/her
potential for becoming a responsible and successful college student in the fields of science, technology, engineering or
math.
___________________________________________________________________________________________________
Signature / Class Taught
Date
Completed recommendations may be: 1) returned to the student in a sealed envelope to submit with their application, 2)
sent directly to: KS-LSAMP Research Immersion Program c/o – Brenee King, Kansas State University, 125 Seaton Hall,
Manhattan, KS 66506 or 3) emailed as a PDF or Word file directly to lsamp@ksu.edu
More information about KS-LSAMP can be found at: www.k-state.edu/lsamp
PERSONAL STATEMENT
2016 Research Immersion: Pathways to STEM (RiPS) Application
Applicant Name: __________________________________________________
Please TYPE an essay explaining why you would like to participate in the Research Immersion: Pathways to STEM (RiPS)
program (May 31, 2016 – July 27, 2016). Please include your academic/career goals and your expectations for the summer
research experience. RiPS participants will be representative of diverse circumstances and experiences. Please describe any
abilities, activities, or other personal information about yourself and/or your family that you wish to share with the review
committee. Examples might include, but are not limited to:
 demonstrated service to particular groups or causes,
 commitment to diversity,
 leadership abilities,
 status as a first generation college student,
 multilingual proficiencies, socioeconomic status,
 and/ or a personal history of overcoming hardships.
Essays should be no longer than one page, single-spaced.