LAMP Participant Tracking and Information Form
GENERAL INFORMATION
Last Name: First Name: Middle Initial:
Date of Birth (mm/dd/yy): Gender: Please select Male Female Ethnicity: Please select American Inidian or Alaskan Native Asian or Pacific Islander Black, not Hispanic Hispanic
Social Security Number:
CURRENT ADDRESS
Street: Apartment #: City: State:
Zip:
Current Phone (please include area code) : Permanent Email:
PERMANENT ADDRESS
Permanent Phone (please include area code) :
What year did you participate in the LAMP Summer Research Program?
What grade level were you in? Please select Sophomore Junior Senior
EDUCATION INFORMATION
Undergraduate major: Date of Graduation (mm/yy):
Degree:
Institution:
Do you expect this degree to be your FINAL degree? Please select Yes No
If NO, what is the FINAL degree you anticipate receiving? Please select M.S./M.A. Ph.D. Professional degree (e.g. M.D., D.D.S., J.D., etc.) Other
If other, please specify:
In what year do you hope to receive this degree?
From what institution do you hope to receive this degree?
Are you currently enrolled in graduate school? Please select Yes No
EMPLOYMENT INFORMATION
What is your CURRENT employment status? Please select Employed full-time Employed part-time Unemployed and seeking employment Unemployed and NOT seeking employment
If you are UNEMPLOYED, what is the most important reason for not working? Please select Current Student Suitable job not available Constraints due to family or marital status Health or personal reasons Other
If other reason, please specify:
ASSESMENT OF LAMP SUMMER RESEARCH PROGRAM
To what extent did your participation in a research participation program influence your decision on the following: (select the number that corresponds to your response for each item).
1 = Not at all 2 = Small extent 3 = Some extent 4 = Large extent Whether to attend graduate school: Please select 1 2 3 4 Your choice of graduate school: Please select 1 2 3 4 Your area of specialization: Please select 1 2 3 4 The level of your final degree: Please select 1 2 3 4 Your current occupation: Please select 1 2 3 4 Your current and past research activities: Please select 1 2 3 4
On a scale of 1 to 10, with 1 representing very dissatisfied and 10 representing very satisfied, how would you rate your overall experience in the LAMP Summer Research Program?
Have you participated in any subsequent research programs? Please select Yes No If yes please specify:
Based on past experience with the Tulane LAMP Program, your undergraduate education, and your current graduate, professional, or work experience, what more can be done to better prepare students for careers in science, technology, engineering, and math fields?
Thank you for providing us with your information.
By entering my initials here, (first and last name) I confirm that the information provided is true and complete to the best of my knowledge.