MESA Engineering Program Application
CIN *
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Last Name *
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Middle Name
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First Name *
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Email *
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Email *
repeat email
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Cell Phone *
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Home Phone *
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University Major *
Did you transfer to Cal State L.A. *
I participated in the following MESA Programs *
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Academic Advisor *
Indicate your first quarter and year at Cal State L.A. *
i.e. Fall 2012, Winter 2013
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Class Standing *
Gender *
Ethnicity *
Number of college/university units completed *
please check GET
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Did you participate in MEP last year? *
Name of High School
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Year graduated from high school
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High School City and State
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High School City GPA
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SAT Verbal
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SAT Math
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ACT Verbal
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ACT Math
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My high school offered Advanced Placement (AP
My high school offered Calculus
I had a laboratory in each science course I took in high school
The lab facilities in my high school were
My high school was
Name of Community College or University (if applicable)
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Community College or University City and State (if applicable)
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Transfer GPA (if applicable)
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Mother's Place of Birth ( City, State, Country)
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Mother's Highest Level of Education
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Father's Place of Birth ( City, State, Country)
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Father's Place of Birth ( City, State, Country)
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Father's Highest Level of Education
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I am receiving financial aid
My family provides major help with the cost of my college education
I am treated as an independent student for financial aid
My family income is
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How many people live in your home
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How many hours do you work during school
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Programs in which you have participated or are participating
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