Qualtrics Survey | Qualtrics Experience Management

Scholar Development Plan

Your scholar development plan is due on January 22, 2025.

HLSAMP Scholar Name (Last, first)

Texas State Student ID number (begins with A0)

Date of birth

Your Texas State email address

Local street address

City, State, Zip Code

Cell phone number

Permanent home street address

City, State, Zip Code

Emergency Contact Name (Last, First)

Emergency Contact relationship to you

Emergency Contact's Address and Phone Number

I give my permission to share my email address and GPA with the National Science Foundation to meet NSF program reporting requirements.

I agree

I give my permission for my photo and program information to be used for program-related and promotional purposes and on the H-LSAMP website, Facebook, LinkedIn, Instagram, X, and other social media sites.

I agree

I give my permission to share my Texas State email address and cell phone number with my fellow H-LSAMP members and the front desk staff in the Collaborative Learning Center.

I agree

Major

Minor (if applicable)

Anticipated date of graduation - month and year

I am a member of the University Honors program

Yes
No

Please list the names of all student organizations that you are a member of

Collaborative Learning Center Tutoring - 2 hours per week is required. NOTE: CLC is open Monday through Thursday 9am-6pm. My schedule is:

If you would like peer tutoring from another H-LSAMP scholar in the CLC, please indicate what course(s) you need help in.

Faculty Mentor Meetings [ 3 meetings per semester, minimum required ]. List name of your faculty mentor for this semseter. (Note: If you do not know who your mentor will be - OR - if you want to change your mentor, please provide details below):

Faculty Mentor's department

Film Choices (fill out only if you are participating in Science Cafe) Rank your book choices 1 - 7 with 1 being your top choice. See book covers and descriptions on the HLSAMP website.

1 Broad Band
2 The Body Keeps the Score
3 The World According to Garp
4 The Happy Life
5 Tender is the Flesh
6 The Song of Achilles
7 The Gods Themselves

My semester project(s) - 24 hours required over the course of the semester - check as many boxes as apply and explain your choice(s) below.

To select multiple options in a row, click and drag your mouse or hold down Shift when selecting. To select non-sequential options, hold down Control (on a PC) or Command (on a Mac) when clicking. To deselect an option, hold down Control or Command and click on a selected option.

Title/ description of your research (if applicable).

Name of project supervisor(s).

Department or location where your project(s) will be conducted.

Explain your choice(s) above. Please provide thorough details about what you will be doing including your roles and responsibilities.

What interests you most about this project and what do you hope to contribute?

How is this project related to your university education and STEM career goals?

A minimum of 24 hours over the course of the semester is required for your project activity. For the above named project(s), how many hours will you accumulate?

Summer 2025 Plans - check as many as apply.

I will graduate in May 2025
I will graduate in August 2025
summer undergraduate research experience (REU)
summer internship or job shadowing
I am interested in study abroad summer opportunities.
I will be taking classes on campus
I have (or plan to get) a summer job
Other

I am working on/off campus this semester.

Yes
No

If you answered "yes" to the question above, where are you working?

How many hours per week are you working?

Do you have any family responsibilities this semester?

No
Yes

If you answered "yes" to the above question, please provide details below.

Have you applied for any other scholarships this year?

No
Yes

Do you have any journal publications (accepted or pending)? If so, please list the name of the journal and the title of your article.

Do you wish to attend a professional or academic conference? If yes, which one(s)?

Anything else you'd like to tell us as you begin your spring semester?