2025 LSUHSC-NO, School of Medicine, Office of Community Engagement & Health Equity Programs Tiger Scholars Summer Undergraduate Enrichment Program Registration Form
Please complete the form below to apply for this program. Application deadline: Extended to Tuesday, April 15, 2025, 11:59 PM; second extension: Friday, May 16th, 2025.
Full Name
*
First Name
Middle Name
Last Name
Current Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail Address
*
example@example.com
Mobile Number
*
Phone Number
*
Alternate Phone Number
*
Emergency Contact Phone Number
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Relationship to Emergency Contact
*
Are you a U.S. citizen?
*
Yes
No
If you are not a U.S. citizen, please indicate status.
*
Have you participated previously in academic enrichment programs?
*
If applicable, where did you participate in the previous academic enrichment program?
*
Copy of Driver's License or Government Issued Identification
*
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Transcript 1 from current academic institution
*
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Transcript 2 (if applicable)
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Transcript 3 (if applicable)
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Personal Statement
*
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Recommendation 1
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Recommendation 2
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