Student Profile Creation

Personal Information

*First Name:

Mid Name:

*Last Names:

*Email

Password:

Confirm password:

IMPORTANT: If you are seeking financial aid from any PR-LSAMP program you need to provide your Social Security number. But if you only wish to participate in a event (like JTM-PRISM) you may leave this field blank.

Social Security:

*Student ID:

*Gender:

Female

Male

Non-binary

Not listed

*Age:

*Are you an U.S. citizen or permanent resident:

Yes

*Phone:

Postal Address (regular mail address)

*Street

*City:

*State:

*Zip code:

Academic Information

*Student Status:

High school student

Undergraduate student

Graduate student

*Institution:

*If your institution not in list write in here:

*Date accepted on Institution:

(Month)

(Year)

*Department or Faculty:

*Discipline or Major:

*General GPA:

*Field of study GPA:

*Credits approved:

*Graduation date:

(Month)

(Year)

*Year of study:

Freshman

Sophomore

Junior

Senior

*Highest degree desired:

Bachelors

Masters

Doctorate

Post-Doctorate

*Financial Aid:

None

Pell

PR-LSAMP

Other:

Future Plans

*Planning to attend graduate school:

Yes

*Enter institution(s) separated by comma:

*Expected admission date:

(Month)

(Year)

Your current status

*You have finished your bachellor degree:

Yes

*You are currently working:

Yes

*Indicate if your job is related to any of the STEM fields (Science, Technology, Engineering or Math):

Yes, my job is related to science, technology, engineering or math.

No, my job is not related to science, technology, engineering or math.

Select which sectors do you currently work (you may check more then one):

Industry

Private

Academia

Government

Post Doc

*Certify:

I hereby certify that all the information included in this application is correct and agree with the Terms and Conditions for the use of this registration system. I also authorize the PR-LSAMP Program to disseminate individual and aggregate data, pictures or any other type of information regarding my participation in the PR-LSAMP activities.

Creating Student Profile