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Contact Information |
| First Name:
* |
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| Last Name:
* |
Maiden (if different):
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| Middle Initial |
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| Mailing Address:
* |
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| Address (cont.) |
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| City: * |
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| State/Province:
* |
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| Zip/Postal Code:
* |
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| Cell Phone:
* |
111-111-1111
Alternative Phone:
111-111-1111 |
| E-mail: * |
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Academic Year Status
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*During the 2010 -
2011 (Sept 2010 - August 2011) Academic Year, What was your academic
status?
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Graduate School - Degree Earned
Select No if you have not completed a graduate degree.
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| Have you earned a graduate degree*: |
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Date Conferred: |
mm/dd/yy |
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Institution: |
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Major/Field: |
Other: |
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Type of Degree: |
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| If you have earned a degree
or are not currently enrolled,
Click here to skip
to Personal Information |
Graduate School - Currently Enrolled
Select No for Degree Sought if you are NOT currently attending graduate school
and have not earned a graduate degree, then click the link to skip to Delayed
Entry |
| Degree Sought*:
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If
you entered No, click here to skip to Delayed Entry |
Other:
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| If Currently
in a Program,
Enrollment/Start Date: |
mm/dd/yy |
Institution:
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Major/Field |
Other: |
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Type of Degree: |
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| Are you currently conducting research? |
Yes If yes, Please list research
No |
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List scholarships, assistantships, etc. including amount and
duration if known |
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List any activities you are involved with or any special honors
and/or awards |
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If you are currently in Graduate School and have completed
this section, Click here to go to
Personal Information |
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Graduate School -
Delayed Enrollment Complete if you have delayed
enrollment in graduate school |
| Applications Filed: Institution 1:
Institution 2:
Institution 3: |
Location:
Location:
Location: |
| What is the reason for delaying your graduate school enrollment? |
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| What can
the McNair Program do to expedite your graduate school enrollment: |
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| Do you plan to
enroll in graduate school: |
within the academic
year (2011-2012)
in two or more years
(2013+)
in the
following academic year (2012-2013)
never
not sure |
Personal Information
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Please list any additional information you would like to share
such as work experience, family plans, educational goals, etc. that would be of
interest to the McNair family |
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What would you say was the one greatest
benefit of your participation in the McNair Program? |
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Will you attend the McNair Reunion during College
Night/Homecoming Week in February?
Yes
No
