Bridge to the Doctorate Program

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1 BENEFITS TO FELLOWS Full Graduate Tuition and Fees $30,000 Annual Stipend for Two Years (Pending NSF Funding) Conference and Research Travel Opportunities Participation in Seminars and Workshops Participation in Graduate and Professional Student Associations Preparation for Successful Application to Ph.D. Programs Extensive Academic Support A Diverse and Interactive Community Bridge to the Doctorate Program STUDENTS ELIGIBLE FOR A BD FELLOWSHIP U.S. Citizen or Permanent Resident of the U.S. Undergraduate BS Degree in a STEM Discipline Minimum 3.0 Undergraduate GPA Participation in an Undergraduate LSAMP Program. Acceptance as a First Time Graduate Student to a UAB STEM Graduate School Ph.D. Program. Committed to Pursuing a Doctoral Degree in a STEM Discipline GRADUATE STUDY AREAS Science - Technology Engineering Mathematics Applied Mathematics, Biochemistry, Biology, Biomedical Engineering, Biostatistics, Cell Biology, Cellular & Molecular Biology, Chemistry, Civil Engineering, Computer and Information Sciences, Computer Engineering, Electrical Engineering, Environmental Health Engineering, Epidemiology, Forensic Science, Genetics, Materials Engineering, Materials Science, Mathematics, Mechanical Engineering, Medical Sociology, Microbiology, Neuroscience, Nutrition Science, Physics, Psychology/Behavioral Neuroscience, Developmental Psychology, Medical/Clinical Psychology, Toxicology and Vision Science Application Requirements: A completed Bridge to the Doctorate Application Form: a 2-3 page typed statement that indicates your career plans, why you wish to participate in the program and how your past experience supports your ability to successfully complete the doctoral degree in a STEM discipline; a minimum of (3) letters of recommendation (from your department chair, your research advisor(s) and a professor from your major); and an official transcript. To request additional information, contact: Dr. Louis Dale, Vice President for Equity and Diversity 401 Campbell Hall, Birmingham, AL (205) * (205) (Fax) or

2 PERSONAL INFORMATION Alabama Louis Stokes Alliance for Minority Participation APPLICATION FORM (please type) Name: Last First Middle Initial Date of Birth: month/day/year Social Security Number: Permanent Address: Current Address: Phone No: Address: Phone No: Address: Give the name, address and telephone number for parents, guardians and/or spouse: CHECK ALL ITEMS THAT APPLY: Marital Status: Gender: Citizenship: Ethnicity: Single Male U.S. Citizen Black, non-hispanic American Indian or Alaskan Native Married Female Permanent Resident* Asian or Pacific Islander Hispanic Non U.S. Citizen White, non-hispanic Non-resident Alien If permanent resident, please provide Alien#

3 ACADEMIC INFORMATION School(s) Attended Major Type of Degree Graduation Date Cumulative GPA 1. How do you support your college education? 2. Are you currently employed? Yes No PLEASE NOTE THAT STUDENTS WILL NOT BE ALLOWED TO WORK ONCE ACCEPTED INTO THE. If yes, please state the name, address, telephone number and position of employment. 3. Describe any research experience(s) that you have had: 4. Indicate your participation in any special science or mathematics program, workshops, or mini courses: 5. Give the names and contact information of two faculty members who have agreed to write letters of recommendation in support of your application. 6. Please describe your background, interests and career goals:

4 Alabama Louis Stokes Alliance for Minority Participation NOMINATION FORM (Please Type) STUDENT INFORMATION: Name: Last First Middle Initial Social Security Number: Address: City State Zip Code Telephone: Cell Phone: Address: U.S. Citizen or Permanent Resident: Yes No Undergraduate Institution: Undergraduate GPA: Year of Graduation: Undergraduate Major: Undergraduate Minor: Graduate School Major: Intend to Obtain a Ph.D. Yes No GRE: Verbal: Quantitative: NOMINATOR INFORMATION: Institution: Name: Position: Nominator Signature: Date: Telephone: Did the student participate in the LSAMP Program at their undergraduate school? Yes No

5 Alabama Louis Stokes Alliance for Minority Participation FACULTY RECOMMENDATION FORM Applicant s Name: Faculty Member: Position/Title: Institution: Office Address: Telephone: Please write in detail about the applicant s abilities, motivation, special aptitudes and circumstances that lead you to believe that he/she has the potential to successfully complete a research doctoral program and pursue a career in teaching and/or research. You may attach a letter. Faculty Member s Signature: Date:

6 Alabama Louis Stokes Alliance for Minority Participation I certify that all information on this application is correct. Signature of Applicant: Date: Please immediately send your completed application, nomination and faculty recommendation forms with three letters of recommendation to: Dr. Louis Dale Principal Investigator Alabama LSAMP Bridge to the Doctorate Program The University of Alabama at Birmingham rd Avenue South 401 Campbell Hall Birmingham, AL (205) (205) (Fax)

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