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Tennessee Louis Stokes Alliance for Minority Participation (TLSAMP)
Tennessee State University
Participant Application
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Email
*
Your email
Application Semester:
*
(Applications must be submitted each Semester)
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Fall 2023
Spring 2024
TLSAMP Position
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Select one
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Mentee (Freshman or Sophomore)
Mentor (3.0 GPA min.)
Research Assistant (2.8 GPA min)
Tutor (3.0 GPA min.)
Personal Information
First Name:
*
Your answer
Middle Initial:
Your answer
Last Name:
*
Your answer
T-Number:
*
Enter Txxxxxxxx
Your answer
Gender:
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Male
Female
Expected Graduation Date:
*
Please enter Semester/Year - (Semester: Fall, Spring or Summer) Example: Spring/2019
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Race/Ethnicity:
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(Check only one)
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African American
Hispanic American
Native American
Alaskan Native
Pacific Islander
Caucasian
Other
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Citizenship
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(Check only one)
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US Citizen
Permanent Resident
Other
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Permanent Contact Information
Permanent Address:
*
Your answer
City:
*
Your answer
State (i.e., TN):
*
Your answer
Zip:
*
Your answer
High School Name
Applicant's Local Address
*
Your answer
City:
*
Your answer
State:
*
Your answer
Zip:
*
Your answer
Permanent Home Number
(Dorm or Home) xxx-xxx-xxxx
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Applicant's Cell Phone Number
*
(Cell) xxx-xxx-xxxx
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Your Alternative Email:
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