NSF LSAMP Scholarship Application

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1 NSF LSAMP Scholarship Application NEW APPLICANT Please print neatly. Attach your personal statement, and recommendation info. Applications will not be considered without all required information attached. Name: Last First Middle Date of Birth (required): / / U.S. Citizen (circle one) Y / N Home Address: Street Apt # City State Zip Home Phone: ( ) - Address - Very important! Bennett Personal College Address: Cell Phone: ( ) - Classification: What is your Major? Who is your advisor? What is your grade point average as of the end of last semester (or at your High School if you are a freshman)?

2 Please list Biology, Chemistry, Mathematics, Computer Sciences or Physics courses you have completed and the grade you received: Course Title Credit Hours Year Please list all Biology, Chemistry, Math, Computer Sciences or Physics courses you are taking in the Fall Semester of 2013: Course Title Credit Hours List Honors/Scholarships Received: (Use additional sheets if necessary)

3 List Extracurricular/Community Activities in which you participated: (Use additional sheets if necessary). List Professional/Academic/Social Clubs and /or Organizations List all Research Projects & Internship (s) (Completed and Upcoming) that you have participated in and from which institutions: Name of Project Name of Sponsored Institution Area of Research Date

4 Each LSAMP scholar must have been formally admitted to Bennett College; she has declared herself as a STEM major. Each scholar must be in compliance with the Belle Honor Code and the College s attendance policy, she must maintain a grade point average of at least 3.0 overall. LSAMP Scholars are required to be US Citizens. In addition to qualifying academic standards, the LSAMP Scholars are expected to enthusiastically participate in 80% of the following activities: a. High School Initiatives (e.g. Sisters-in-Science) b. Monthly meetings c. Summer Research Experiences d. Enrichment Activities for STEM Majors (e.g. Sciences Division Colloquia, Graduate Prep-Retreat at VA Tech) e. Annual Meeting for all the LSAMP scholars from the Virginia and North Carolina partner institutions. I HAVE READ THE ABOVE AND AM IN COMPLETE AGREEMENT WITH IT. I GRANT THE LSAMP PROJECT DIRECTOR TO REQUEST IN WRITING COPIES OF MY ACADEMIC GRADES AND TRANSCRIPT AND OTHER PERSONALLY IDENTIFIABLE INFORMATION CONTAINED IN MY COLLEGE RECORDS. I CERTIFY THAT THE INFORMATION I HAVE PROVIDED ON THIS APPICATION FORM AND ANY ADDITIONAL MATERIAL THAT I SUBMIT RELATED TO LSAMP SCHOLARSHIP PROCESS IS COMPLETE, ACCURATE, AND TRUE TO THE BEST OF MY KNOWLEDGE. Signature of Applicant: Date:

5 Application Process Checklist: 1. Completed Application: 2. Personal Statement must be submitted 3. (2) Letters of Recommendations RECOMMENDATION FORMS: Give the Name, Title, Department, Office, and Telephone Number of the 2 people completing the Recommendation Forms for you. (Math and Science Faculty one must be a professor in applicant s major department) 1. Name Title Department Address: City/State/Zip Telephone Number ( ) Address: Very important! 1. Name Title Department Address: City/State/Zip Telephone Number ( ) Address: Very important! Please compose a personal statement of approximately words (typed) describing your interest in sciences, your background, science career goals, motivation, and interdisciplinary skills/interests. Be sure to put your name, address, ID #, year, major on the personal statement. Submit applications & recommendation letters to: Dr. Cristina Moreira, room 220, Pfeiffer Sciences, Bennett College, 900 E. Washington Street, Greensboro, NC Recommendation letters can also be ed to Call for additional information.

6 Recommendation Form NSF LSAMP Scholarship student to complete: Last Name First Name Middle Name Bennett s ID Number: Major: Classification: Cell Phone: Other Phone address: Teacher to complete: The above Bennett College for Women student is applying to be a Virginia-North Carolina Louis Stokes Alliance for Minority Participation (LSAMP) scholar. Initiated in 2007, with support from the National Science Foundation (NSF), the VA-NC LSAMP Project is dedicated to increasing the recruitment and retention of students from underrepresented minority groups that pursue careers in science, technology, engineering, and mathematics (STEM). Please complete the following questions to help us evaluate this applicant. 1) How long have you known this student?. 2) Rate the applicant s: Poor Fair Good Excellent Class participation Class attendance Preparedness for class Interest in class 2) Please provide a brief statement that addresses this student s strengths and weaknesses. If you were the director of the applicant s proposed program, would you be eager to have this student as a participant?

7 3) Please give us a final recommendation regarding this students performance: Highly Recommend Recommend Recommend with reservations Do not recommend Signature: Date: Name (please print): Title: Institution: Department: Address: Phone: Address: Any questions please contact: Dr. Cristina Moreira Bennett College LSAMP Project Director Phone: (336)

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