California State University, Sacramento
Louis Stokes Alliance for Minority Participation
Math Honors Program
Summer 2015
Program Description:
California State University, Sacramento (Sacramento State), through its Science Educational
Equity (SEE) Program, will be offering a Math Honors Program (Math AMP) for students
eligible to participate in the California State University-Louis Stokes Alliance for Minority
Participation Program (CSU-LSAMP) at Sacramento State. CSU-LSAMP is a state-wide
program supported by the National Science Foundation (NSF Grant # HRD-1302873) and the
CSU Chancellor’s Office, which is designed to broaden participation in science, mathematics,
engineering and technology (STEM) disciplines. The LSAMP Math Honors Program
consisting of a three-week summer session scheduled for August 3 -August 21, 2015, and
depending on the student's level of readiness will be followed by a either a unique two semester
pre-calculus course (Math 29A and 29B) or a year of calculus (Math 30 and 31), which includes
enrichment workshops ("math labs") during the 2015-2016 academic year (in addition to major
and general education courses). LSAMP students will also be active members of the MESA
Engineering Program (MEP) or the Science Educational Equity (SEE) program.
Student Support:
Students selected for the program will receive compensation up to $675 for active participation
in the LSAMP Math Honors Program. Please note that the amount of compensation is based on
attendance, participation in activities, and completion of assignments.
Eligibility:
To participate in the program students must  Be a U.S. Citizen or Permanent Resident
 Be an individual who faces or has faced social, cultural, educational, or economic
barriers to careers in the fields of science, technology, engineering/computer sciences,
and mathematics.
 Be newly admitted to or be a continuing student at California State University,
Sacramento.
 Be an undergraduate student pursuing a first bachelors degree in a science, technology,
engineering/computer sciences, or math major.
 Demonstrate an interest in pursuing a research career,
 Have a G.P.A. of 2.5 or better and a minimum SAT score of 400 in math or an
equivalent assessment score.
For additional information or to request an application package, please call the Science
Educational Equity Program at CSU, Sacramento (916) 278-6519 or the MESA Engineering
Program (MEP) at (916) 278-6699.
California State University, Sacramento
LOUIS STOKES ALLIANCE FOR MINORITY PARTICIPATION
MATH HONORS PROGRAM
INSTRUCTIONS TO THE APPLICANT:
If you have any questions or would like assistance in completing the application, please call the
Science Educational Equity Program (SEE) at (916) 278-6519 or MESA Engineering Program
(MEP) at (916) 278-6699. After hours, you may leave a message at (916) 278-6519 and your call
will be returned.
1. Complete the enclosed Application Form.
2. Include a copy of high school/college transcripts.
3. Include a copy of SAT/ACT scores.
4. Must provide a current Intermediate Algebra Diagnostic (IAD) or Calculus Ready (CR)
score. Note: Admitted students will take one during their orientation or should make
arrangements in June to take the diagnostic test.
5. Answer the questions on the enclosed Personal Statement Form.
6. Recommendation Forms: Two recommendations (at least one from a teacher) are
required.
7. Complete commitment/release form included in this application packet
Please have each person complete the enclosed recommendation form and submit it directly to
the LSAMP program or have them give it to you in a sealed envelope with their signature for
inclusion with the application materials.
Send all application materials to:
LSAMP Math Summer Program
Science Educational Equity Program
California State University, Sacramento
6000 J Street, Sequoia Hall 315
Sacramento, CA 95819-6119
Phone Number: (916) 278-6519
Fax Number: (916) 278-4640
For priority consideration application must be submitted by Friday, June 12, 2015.
Math Honors Program
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California State University, Sacramento
LOUIS STOKES ALLIANCE FOR MINORITY PARTICIPATION
MATH HONORS PROGRAM
Please type or print (Black or Blue ink only) legibly entire application for consideration
Personal Information
Full Name:Click here to enter text.
Last
Click here to enter text.
Click here to enter text.
First
Address:Click here to enter text.
M.I.
Click here to enter text.
Street Address
Apartment/Unit #
Click
here to
enter text. Click here to enter text.
State
ZIP Code
Click here to enter text.
City
Home Phone:Click here to enter text.
Alternate Phone:Click here to enter text.
EmailClick here to enter text.
SSNClick here to enter text.
Sacramento State SID#Click here to enter text.
Birth Date:Click here to enter text. Place of Birth:Click here to enter text.
Expected or
Current Major:Click here to enter text.
Career InterestClick here to enter text.
Name of Last
School AttendClick here to enter text.
Click here to
Test
enter text.
ScoresClick here to enter text.
GPA
Verbal SAT/ACT Score
Click here to enter text.
Math SAT/ACT Score
Citizenship Status
I am a:U.S. Citizen ☐
Permanent
Resident ☐
Other ☐
Click here to enter text.
Race and Ethnicity:
1) Are you Hispanic or Latino?
☐Hispanic or Latino (A person of Mexican, Puerto Rican, Cuban, Central or South American, or
other Spanish culture or origin, regardless of race)
☐Not Hispanic or Latino
Math Honors Program
☐Decline to State
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California State University, Sacramento
LOUIS STOKES ALLIANCE FOR MINORITY PARTICIPATION
MATH HONORS PROGRAM
Race and Ethnicity Cont.:
2) Regardless of your answer to question 1, please select one or more of the following racial
categories:
☐Black or African-American - A person having origins in any of the black racial groups in
Africa
☐Native Hawaiian or Other Pacific Islander - A person having origins in any of the original
peoples of Hawaii, Guam, Samoa, Polynesia, Micronesia, or other Pacific Islands
☐American Indian - A person having origins in any of the original peoples of North America
and maintaining cultural identification through tribal affiliation or community recognition
☐Alaska Native - A person having origins in any of the original peoples of Alaska, including
Eskimos or Aleuts
☐Asian - A person having origins in any of the original peoples of East Asia, Southeast Asia, or
the Indian subcontinent. This area includes, for example, China, India, Indonesia, Japan, Korea,
and Vietnam
☐White - A person having origins in any of the original peoples of Europe, North Africa, or the
Middle East
☐Other (specify):
Click here to enter text.
☐Decline to State
List all math courses you are taking or have completed in High School or College
Course
Click here to enter text.
Grade Received
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Please list the names and titles of persons who will submit recommendations on your behalf
Name
Title
Click here to enter text.
Click here to enter text.
Click here to enter text.
Math Honors Program
Click here to enter text.
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California State University, Sacramento
LOUIS STOKES ALLIANCE FOR MINORITY PARTICIPATION
MATH HONORS PROGRAM
In the space below or on a separate sheet of paper, please answer the following questions.
a. Describe any cultural, social, or economic barriers you have faced in your pursuit of higher
education?
Click here to enter text.
b. Why are you interested in science, engineering or math?
Click here to enter text.
c. Describe an experience where you were proud of yourself for a personal accomplishment.
Click here to enter text.
d. Why are you interested in the LSAMP program, what do you expect to gain from
participating in the program?
Click here to enter text.
e. Describe how your participation in CSU-LSAMP will contribute to the program's goals of
broadening participation in science, mathematics, engineering and technology (STEM)
disciplines?
Click here to enter text.
Math Honors Program
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California State University, Sacramento
LOUIS STOKES ALLIANCE FOR MINORITY PARTICIPATION
MATH HONORS PROGRAM
Commitment/Release Form
Name: Click here to enter text.
PROGRAM COMMITMENT
If selected for the Louis Stokes Alliance for Minority Participation LSAMP program, I am
prepared to fully participate in all program activities. I am aware that the LSAMP is a
challenging, honors program. I am prepared to commit myself and my time to it.
Signature: __________________________________
Date: ______________________
Releases:
By signing below, I authorize use and public display of any photographs taken of me during my
participation in the LSAMP Program. In addition, I authorize the project to track my progress in
higher education and to provide contact information to other educational institutions with the
goal of advancing my progress in my educational career. This includes tracking which requires
use of my Social Security Number as identifying information.
Signature: ___________________________________
Date: _______________________
FOR OFFICE USE ONLY:
Application Received ______________
Staff Initial: __________
This Student is:
 Not Accepted
Accepted
Action taken by: ___________________________
Print name
_________________________
Signature
___________________________
Title
_________________________
Date
Math Honors Program
Page 5
2/10/2016
California State University, Sacramento
LOUIS STOKES ALLIANCE FOR MINORITY PARTICIPATION
MATH HONORS PROGRAM
Recommendation Form
California State University, Sacramento (Sacramento State), through its Science Educational
Equity (SEE) Program, will be offering a Math Honors Program for students eligible to
participate in the California State University-Louis Stokes Alliance for Minority Participation
Program (CSU-LSAMP) at Sacramento State. CSU-LSAMP is a state-wide program supported
by the National Science Foundation (NSF Grant # HRD-1302873) and the CSU Chancellor’s
Office, which is designed to broaden participation in science, mathematics, engineering and
technology (STEM) disciplines.
The LSAMP Math Honors Program consisting of a three-week summer session scheduled for
August 3 - August 21, 2015, and depending on the student's level of readiness will be followed
by a either a unique two semester pre-calculus course (Math 29A and 29B) or a year of calculus
(Math 30 and 31), which includes enrichment workshops ("math labs") during the 2015-2016
academic year (in addition to major and general education courses).
Name of ApplicantClick here to enter text.
How long have you known the applicantClick here to enter text.
What is your relationship to the applicantClick here to enter text.
Please check the most appropriate response:
Excellent
Scholastic Ability
Intellectual Potential
Initiative
Self Discipline
Creativity
Integrity
Social Skills
Leadership
Persistence
☐
☐
☐
☐
☐
☐
☐
☐
☐
Above Average
Average
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Below Average
Unable to Judge
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
-over-
Math Honors Program
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2/10/2016
California State University, Sacramento
LOUIS STOKES ALLIANCE FOR MINORITY PARTICIPATION
MATH HONORS PROGRAM
Recommendation Form
If you would like to qualify any of the ratings, or would like to make additional comments,
please use the space below or attach a separate sheet of paper. We would appreciate any candid
comments you may have concerning this applicant’s qualifications, personal attributes, and
potential for success in science, engineering, or math.
Click here to enter text.
Name PrintedClick here to enter text.
TitleClick here to enter text.
Signature
DateClick here to enter text.
Day time Phone #Click here to enter text.
Recommendations should be completed and submitted to the attention of:
LSAMP Math Summer Program
Science Educational Equity Program
California State University, Sacramento
6000 J Street, Sequoia Hall 315
Sacramento, CA 95819-6119
Phone Number: (916) 278-6519
Fax Number: (916) 278-4640
All application materials should be submitted by the priority application due date Friday,
June 12, 2015.
Math Honors Program
Page 7
2/10/2016
California State University, Sacramento
LOUIS STOKES ALLIANCE FOR MINORITY PARTICIPATION
MATH HONORS PROGRAM
Recommendation Form
California State University, Sacramento (Sacramento State), through its Science Educational
Equity (SEE) Program, will be offering a Math Honors Program for students eligible to
participate in the California State University-Louis Stokes Alliance for Minority Participation
Program (CSU-LSAMP) at Sacramento State. CSU-LSAMP is a state-wide program supported
by the National Science Foundation (NSF Grant # HRD-1302873) and the CSU Chancellor’s
Office, which is designed to broaden participation in science, mathematics, engineering and
technology (STEM) disciplines.
The LSAMP Math Honors Program consisting of a three-week summer session scheduled for
August 3 - August 21, 2015, and depending on the student's level of readiness will be followed
by a either a unique two semester pre-calculus course (Math 29A and 29B) or a year of calculus
(Math 30 and 31), which includes enrichment workshops ("math labs") during the 2015-2016
academic year (in addition to major and general education courses).
Name of ApplicantClick here to enter text.
How long have you known the applicantClick here to enter text.
What is your relationship to the applicantClick here to enter text.
Please check the most appropriate response:
Excellent
Scholastic Ability
Intellectual Potential
Initiative
Self Discipline
Creativity
Integrity
Social Skills
Leadership
Persistence
☐
☐
☐
☐
☐
☐
☐
☐
☐
Above Average
Average
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Below Average
Unable to Judge
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
-over-
Math Honors Program
Page 8
2/10/2016
California State University, Sacramento
LOUIS STOKES ALLIANCE FOR MINORITY PARTICIPATION
MATH HONORS PROGRAM
Recommendation Form
If you would like to qualify any of the ratings, or would like to make additional comments,
please use the space below or attach a separate sheet of paper. We would appreciate any candid
comments you may have concerning this applicant’s qualifications, personal attributes, and
potential for success in science, engineering, or math.
Click here to enter text.
Name PrintedClick here to enter text.
TitleClick here to enter text.
Signature
DateClick here to enter text.
Day time Phone #Click here to enter text.
Recommendations should be completed and submitted to the attention of:
LSAMP Math Summer Program
Science Educational Equity Program
California State University, Sacramento
6000 J Street, Sequoia Hall 315
Sacramento, CA 95819-6119
Phone Number: (916) 278-6519
Fax Number: (916) 278-4640
All application materials should be submitted by the priority application due date Friday,
June 12, 2015.
Math Honors Program
Page 9
2/10/2016