STEM PREP PROGRAM APPLICATION

    First Name (required)

    Last Name (required)

    Email Address (required)

    Phone Number

    Address (academic year)
    Street
    City
    State
    Zip Code

    Address (permanent)
    Street
    City
    State
    Zip Code

    Academic Information

    University

    Major(s)

    GPA

    Year of Study in Spring 2022

    References
    Please provide contact information for two faculty members you have asked to provide letters of recommendation.

    Faculty Recommendation #1
    Name
    Institution
    Email
    Phone

    Faculty Recommendation #2
    Name
    Institution
    Email
    Phone

    Area of Interest Preferences
    To place you in the lab that conducts research programs that interest you, please select your top three (3) areas of interest. You do not have to rank any of the topics if you are still undecided about your areas of interest. Use your Statement of Interest to tell us more about your current academic and professional goals. To review a short description of each research area visit the STEM Prep Program program page.

    First Choice

    Second Choice

    Third Choice

    DEMOGRAPHIC INFORMATION

    NOTE: LUMCON is committed to offering research opportunities for all students. By providing answers to the questions below you help LUMCON identify the demographics of the students that apply to our summer programs. This information is helpful in the design, implementation, recruitment, and funding of future programs at LUMCON. You are NOT REQUIRED to provide answers.

    Gender (select One)
    MaleFemaleI describe my gender differently

    Citizenship Status (select one)
    U.S. CitizenU.S. Permanent ResidentOther non-U.S. Citizen

    Ethnicity (select one)
    I prefer not to answerHispanic or Latino – A person of Mexican, Puerto Rican, Cuban, South or Central American, or other Spanish culture or origin, regardless of race.Not Hispanic or Latino

    Race (select all that apply)
    I prefer not to answerAmerican Indian or Alaskan Native – A person having origins in any of the original peoples of North, South, or Central America, and who maintains tribal affiliation or community attachment.Asian – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.Black or African American – A person having origins in any of the black racial groups of Africa.Native Hawaiian or Pacific Islander– A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands.White – A person having origins in any of the original peoples of Europe, Middle East, or North Africa.Other

    Disability Status (select all that apply)
    I prefer not to answerHearing ImpairmentVisual ImpairmentMobility/Orthopedic ImpairmentOther (please explain in your Statement of Interest)None

    Family Education History
    Are you a first generation college student (neither parent received a four-year college degree)? YesNo

    How did you learn about the LUMCON STEM Prep Program? (check all that apply)
    LUMCON websiteCollege faculty or departmentEmail ListservFacebook or other social mediaFlyerPresentation by a LUMCON Representative

    Did you apply to any other summer programs this year?
    YesNo

    ATTACHMENTS
    Files must be in one of the following formats (.pdf, .doc, or .docx).

    1. One page statement of interest.

    2. Resume

    3. Current college transcript (unofficial or official copies are accepted)

    4. Two letters of reference: Make sure you download the cover page from the Application Process Page. Have these emailed from faculty directly to education@lumcon.edu

    To prove you're human, please solve this simple math problem: