McNair Scholar Prep Program

Name:

Student Number:

Major:

E-mail:

School Mailing Address:

School City: School Zipcode:

School Phone:

Permanent Mailing Address:

Permanent City:

Permanent State: Permanent Zipcode:

Permanent Phone:

Classification: Freshman Sophomore Junior

Scholar Prep Status: New Scholar Prep Continuing Scholar Prep

Are you a first generation college student(neither parent completed a bachelor's degree; or if you regularly resided with and received support from only one parent, that parent did not complete a baccalaureate degree)?

Yes
No

Racial/Ethnic Background:

African-American
Alaskan Native
American Indian
Asian American
Caucasian
Hispanic-American
Other:

Academic and extracurricular awards, honors, and scholarships (Freshman may include High School information):

Memberships and participation in academic/campus organizations and activities:

Please explain in 300 words or less why you want to participate in this program and how we can help you reach your goal: