Kentucky State University s1

Kentucky State University LOUIS STOKES ALLIANCE FOR MINORITY PARTICIPATION 2011 Summer Bridge Program for Rising Juniors & Seniors APPLICATION FORM

Name:______e-mail:______

Mailing Address:______

City:______State:______Zip Code______

Parent/Guardian:______

Telephone: (Home):______(Cell):______

Current Grade:______Grade Point Average:______ACT: Com.______Math______

Current School:______School Attending in Fall 2011:______

Awards/Achievements: ______

College/Career Plans: (200-250 words. Type in the space below or attach a separate page):______

Please enclose (or e-mail) two letters of recommendation and a copy of current transcript. Accepted applicants must participate in all LSAMP activities during the program. (June 12th to July 1st, 2011) Electronic application accepted. Applicants will be notified via e-mail only. Application deadline: April 15, 2011. Mail Application to: Criteria for Application: Dr. Kazi Javed 1) Rising HS Juniors or Seniors Kentucky State University 2) Overall high school GPA of 2.8 or better 400 East-Main St. 3) ACT score of 20 or better Frankfort, KY 40601 4) Completed application, transcripts, (502)597-6722 two recommendation letters, one picture. [email protected]