Louis Stokes Alliance for Minority Participation

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MI-LSAMP Undergraduate Student Research Application

Personal Information

* Name

First:
Last:

* Address

Street 1:
Street 2:
City:
State:		Zip:

* Home Phone Number

* Cell Number

Work Number

* Date of Birth

(mm/dd/yyyy)

* Gender

Male Female

* Email

* US Citizen

Yes
No

Ethnicity

(check all that apply)

African American

American Indian

Asian

Hispanic

Caucasian

Do not want to disclose

Other Ethnicity

Academic / Research

* Current Institution

Michigan State University
University of Michigan
Wayne State University
Western Michigan University
Other:

Institution of Interest for Research

(check all that apply)

Michigan State University

University of Michigan

Wayne State University

Western Michigan University

Desired times(s) of year

(check all that apply)

Fall

Winter

Summer

* What is your Academic Concentration

* GPA

* Research Interests

* Previous Research Experience

* Relevant Coursework in Science/Math/Technology/Engineering

Awards/honors

Extracurricular Activities

Additional Information

List other engineering, math, technology, science, or special programs (e.g., DAPCEP, LSAMP Summer Program, REU's) in which you have participated.

In the space below, provide more information about your research interests. Explain why you are interested in being placed as an intern in a research environment.

Make sure to email an updated copy of your resumé and most recent transcript (an unofficial student transcript is acceptable) to your university's Program Manager:
University of Michigan - Elaine M. Dowell - um-lsamp@umich.edu
Michigan State University - Theodore Caldwell - caldwell@egr.msu.edu
Wayne State University - Michelle Reaves - wsu-lsamp@eng.wayne.edu
Western Michigan University - Dr. Andrew Kline- andrew.kline@wmich.edu