Spring Internship/Summer Program: June, 2025

CSTEP Application
Student Eligibility:
1. New York state resident
2. Full time college or graduate student, during our CSTEP program
3. African-American, Hispanic/Latino, American Indian or Alaskan native
4. If you are not African-American, Hispanic/Latino, American Indian or Alaskan native, you can qualify as an economically disadvantaged student. Please refer to this chart.
Upon completing this initial application and submission, you'll get an email for the following documents, so please make sure you start obtaining them:
1. Current College Transcript (unofficial transcript is acceptable)
2. Current class schedule or course registration
3. Signed Letter of Recommendation (from a Professor, Supervisor, Counselor, or other non-family member who can speak to your character and potential success in our program. Note: If you letter writer does not want to give you a copy of the letter to upload, you can have them email it to cstep@sunyopt.edu instead.
4. Document verifying household income (i.e., first page of parent’s most recent IRS 1040 form)
** The deadline for our CSTEP applications and supplemental documents for this cycle is on Monday, April 7, 2025, by 12:00pm EST **

* denotes a required field.
Application for*

Spring Internship: June 2, 2025 - June 13, 2025Summer Academic Program: every Tuesday from June 10, 2025 - August 5, 2025
First Name*
Middle Name*
Last Name*
Present Address
Address*
Apt
City*
State*
Zip Code*
Telephone*
Personal Email*
example@gmail.com
School Personal Email*
example@sunyopt.edu
Date of Birth*

MonthDayYear
Date of Birth
Permanent Address (if different)
Address
Apt
City
State
Zip Code
Legal State of Residence*
Country of Birth*
If permanent registered alien, Registration Number
Ethnicity*

AsianNative Hawaiian or other Pacific IslanderAfrican-American/BlackWhite/CaucasianHispanic/LatinoNative-American Indian/Alaskan
Sex*

MaleFemaleX
“X” may be used by and individual to indicate sex or gender where they feel “male” or “female” would not be appropriate. “X” may include, but is not limited to, the following:
- Transgender
- Trans man
- Trans woman
- Non-binary
- Gender non-conforming
- Agender
- Bigender
- Pangender
- Questioning or unsure
- Prefer not to specify
Education
Are you a first generation college student?*

YesNo
Year first matriculated into college*
Are you a transfer student?*

YesNo
If yes, which institution
School Currently Attending*
Class Level *
ex: Fr, So, Jr, Sr
Expected Date of Graduation*

MonthDayYear
Expected Date of Graduation
Expected Date of Graduation
Major*
Second Major (if applicable)
Intended Career*
Pre-Professional Program of Study*
Overall GPA*
Science GPA*
Math GPA*
SAT Scores: Verbal
Math
Writing
Parental Information
Father's Name*
Mother's Name*
Total Annual Family Income*
Number of Members in Household*
Sources of Income*
Have you ever participated in any of the following State-sponsored programs?

P-TECHSmart Scholars Early College High SchoolLPPSTEPCSTEPEOPSEEKCollege DiscoveryHEOPOther New York State Opportunity Programs
If you participate in any of the above programs at your school, please list: 1) Name of program, director or coordinator’s name, their phone number, and date(s) you were in program.

0/500
If you participate in any of the above programs at your school, please give:
Director or Coordinator's Name
Telephone
NOTE: Being a member of CSTEP at another College does not preclude you from participating in SUNY Optometry’s CSTEP Internship Program.
Have you ever had your eyes examined by an optometrist?*

YesNo
Have you ever spoken to an optometrist about his/her profession?*

YesNo
In 500 words or less, please write an essay answering the following question: From what you already know about optometry and our CSTEP program, please explain how the CSTEP Internship will benefit you in your professional pursuits?*

0/500
Please verify that you are human*
Should be Empty:

CSTEP Application

Present Address

Permanent Address (if different)

﻿Education

﻿Parental Information

Education

Parental Information