LSAMP Application for Participation - Northeastern University College of Engineering

Please complete the inquiry form below to express interest in the Northeastern University College of Engineering LSAMP Scholarship.

Please direct any questions to Richard Harris via email at r.harris@northeastern.edu.

Name(Required)

First Last

NU ID#(Required)

Northeastern Email(Required)

Cell Phone#(Required)

College(Required)

Expected Northeastern Graduation Year(Required)

Where did you learn about LSAMP?(Required)

What are your career interests?(Required)

Please describe any research experiences you have had or are currently engaged in:(Required)

Please explain why you would like to be a part of LSAMP(Required)

Gender (In order for the University to obtain appropriate housing, please identify your gender.)(Required)

Male

Female

Other

Are you a US Citizen or Permanent Resident? (Only citizens or permanent residents of the United States of America are eligible for inclusion in the LSAMP program.)(Required)

Yes

Ethnicity/Race - Please check all that apply:

Hispanic/Latino (including Spain)

American Indian or Alaskan Native (including all Original People of the Americas)

Asian (including Indian subcontinent and Philippines)

Black or African American (including Africa and Caribbean)

Native Hawaiian or Other Pacific Islander (Original Peoples)

White (including Middle Eastern)

All campus undergraduate students are eligible to participate in the Northeastern University Louis Stokes Alliance for Minority Participation program. However, the funding for this program comes from the National Science Foundation and therefore certain opportunities can only be awarded to individuals in the target population. Completing this section of the form will help us determine which opportunities you are eligible to receive, but will not prevent your ability to become an LSAMP scholar.