Louisiana Alliance for Minority Participation LAMP


LAMP Student Demographic Sheet


Name _____________ _____________                        SS# ___________________ 
                   Last                       First              MI

Sex: (circle one)         Male                    Female

Martial Status: (circle one)     Single           Married           Divorced

Minority Status: ____African American            ____American Indian
                        ____Hispanic        ____Alaskan Native       ____Other

Date of Birth: _________________

Home Address: _____________________________________

                              City                   State                  Zip Code

Email Address: ___________________          Phone: (day) __________________

High School _________________________      Location _______________________

Date Graduated ______________________       Prospective Major ________________

GSU Classification: (circle one)    Freshman          Sophomore         Junior          Senior

Major _____________________

Expected Date of Graduation ___________________________

Are you planning to continue your education in pursuit of a Masters or Doctoral Degree? _______

If yes, in what field of study? __________________________

How did you learn about LAMP? (Posters, high school counselor, peers, newsletters, etc.)

ROTC Affiliation __________________      Military Status ________________