California Central Coast Community College Collaborative (C6) Student Interest Form

Become a C6 LSAMP Scholar and position yourself to participate in the STEM network including research and internships, career development, events, and academic success opportunities.

Please don't fill out this input box.

Personal Information

Last Name*

First Name*

Middle Initial

Birthdate MM/DD/YYYY*

Phone Number (XXX) XXX-XXXX*

Community College*

If you selected "Other," please list the name of your community college here:

College ID Number*

College Email Address*

Please select the category your major applies to:*

If you selected "Other," please list your major here:

If you are unsure, visit to find your major and category.

Please ensure your college has your current major on file in Admissions and Records.

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