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NYC Alliance LS-AMP Spring '16-Fall '16 Application
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* Indicates required question
First name
*
Your answer
Last name
*
Your answer
Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
Email
*
Your answer
Date of birth MM/DD/YYYY
*
Your answer
Male or Female
*
Male
Female
Ethnicity
African-American
Hispanic
Native American
Native Pacific Islander
Other
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Campus
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Choose
Baruch College
The City College
Hunter College
John Jay College
Borough of Manhattan Community College
Bronx Community College
Hostos Community College
Lehman College
Brooklyn College
New York City College of Technology
Kingsborough Community College
Medgar Evers College
College of Staten Island
LaGuardia Community College
Queens College
Queensborough Community College
York College
Major
*
Your answer
Degree Sought
*
Your answer
Telephone number
*
Your answer
GPA
*
Your answer
Number of credits completed
*
Your answer
Expected graduation date: MONTH / YEAR
*
MM/YYYY
Your answer
Permanent Resident or U.S. Citizen?
*
U.S. Citizen
Permanent Resident
No
Project and Mentor Information
The following fields must be filled if and only if you have the required information.
Project Discipline
Leave empty if none
Your answer
Project Title
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Your answer
Project Description (Do NOT exceed 150 words)
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Your answer
Research Mentor Last Name
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Your answer
Research Mentor First Name
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Your answer
Research Mentor's Email
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Your answer
Research Mentor's Phone Number
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Your answer
Describe Student Supervision by Research Mentor (Do NOT exceed 100 words)
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Your answer
Email ALL your supporting documents to:
ampcc@ccny.cuny.edu
. Which of the following documents have you emailed to:
ampcc@ccny.cuny.edu
?
*
Updated Transcript
Resume/CV
Copy of Birth Certificate
Passport or Permanent Residency card
Social Security Card
Required
Semester you plan to work
*
Spring '16-Fall '16
Other Program Participation CUNY Scholars
*
None
MARC
McNair
MBRS
CSTEP
RISC
Bridge-NIH
NOAA Crest
NASA
CUNY Scholars
Other:
Required
If You are Participating in Another Program, list the amount(s).
i.e.:$400
Your answer
Did you apply to the LSAMP program prior to this application term? If so, please state which semester(s) you applied?.
Example: Fall 2015 - Spring 2016, leave empty if you did not
Your answer
Are you eligible for any of the following?
*
Select more than 1 if applicable
Federal Work Study
CUNY Service Corps
None of the Above
Required
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