RONALD E. McNAIR POSTBACCALAUREATE ACHIEVEMENT PROGRAM

PROGRAM APPLICATION

YOU MUST SUBMIT A COPY OF YOUR MOST RECENT TRANSCRIPT.

RECOMMENDATION FORM

TO BE COMPLETED BY THE APPLICANT

TO BE COMPLETED BY THE EVALUATOR

Please return your typed or neatly printed application form with supporting materials to:

McNair Achievement Program

302 Wiecking Center

Minnesota State University, Mankato

Mankato, MN 56001

Date of Application:

Name:

Last First M.I.

Address (current):

Cell ( )

City State ZIP Tel. ( )

Permanent Contact Information :

Name: Address:

City State ZIP Tel. ( )

E-mail Address: Tech ID# :

Date of Birth: Female Male

Month Day Year

Place of Birth: SSN#: - -

Are you a U.S. citizen? yes no If no, are you a permanent resident? yes no

How do you describe yourself? African American/Black Hispanic/Latino Caucasian

Native American (tribe : ) Other ( )

Circle one: Sophomore Junior Senior Major: CUM GPA:

How many credits have you completed including the ones currently enrolled in:

Please list any other academic institutions you have attended, dates of attendance, and GPAs:

What is your projected graduation date? Month: Year: Year of high school graduation:

FAMILY AND FINANCIAL VERIFICATION

The information in this section must be provided by all applicants in order to determine their eligibility for

the McNair Achievement Program. It will be treated confidentially.

Check the highest year of schooling completed by a parent/parents or guardian:

Parent 1:

Grade School Junior High High School A.A. B.A /B.S M.A/M.S. Ph.D.

Parent 2:

Grade School Junior High High School A.A, B.A /B.S M.A/M.S. Ph.D.

Are you currently eligible to receive Pell Grant? yes no

Are you considered dependent or independent according to federal financial aid standards?

If dependent, complete Section A : if independent, complete Section B.

A (Dependent):

What is the size of your parents’ household, including yourself? _________

Did your parents’ file a federal income tax return for tax year 2007? yes no

If yes, what was your Parents’ taxable income listed on their 2007 income tax form?

$____________________

B (Independent):

What is the size of your household, including yourself, spouse, and/or other

dependents? _____

Did you file a federal income tax return for tax year 2007? yes no

If yes, what was your taxable income listed on your 2007 income tax form?

$____________________

If you did not file a tax return and you qualify for the program as a low-income

first-generation student, additional documentation may be required.

(If selected for the McNair Achievement Program, you will need to provide a photocopy of

federal income tax form 1040, 1040A, or 1040EZ, whichever is appropriate, for purposes of

documentation.)

Please list any internships or research experiences you have had:

What research topics/fields/departments are of interest to you?

Please provide the names, titles, addresses, and phone numbers of two persons (e.g. professor, project director, counselor, pastor) you have asked to provide letters of recommendation (using the attached forms) to support your application:

Name: Title:

Address: Tel.: ( ) -

Name: Title:

Address: Tel.: ( ) -

Which of the following best describes your commitment to attend graduate school? (check one):

I am thinking about going to graduate school and would like to explore options.

I am going to graduate school after working one or two years.

I have made a firm commitment to attend graduate school immediately after receiving my bachelor’s degree.

I have made a firm commitment to pursue a master’s degree, but I am uncertain about a Ph.D.

I am committed to attending graduate school and to earning my Ph.D.

Statement of Purpose:

The information provided in this section is important to the selection process. Please type your essay on separate signed sheets and attach them to your completed application. Your essay should be thoughtful, honest, and approximately two pages in length.

Please respond to the following questions/topics:

· Who are you (your family and educational background, your outlook on life, your strengths, your life goals)?

· What are your academic goals, research interests, and career plans?

· Please describe your understanding of the McNair Achievement Program philosophy and its primary objective.

· Why are you interested in participating in the McNair Achievement Program?

· How will the McNair Achievement Program help you achieve your postgraduate and career goals?

· How will the McNair Achievement Program help you contribute to your chosen field of study and to your community?

To the best of my knowledge the information given on this application is accurate, complete, and true.

Signature Date

The Ronald E. McNair Postbaccalaureate Achievement Program

is a federally funded program by the

U.S. Department of Education.

Minnesota State University, Mankato is an

Affirmative Action/Equal Opportunity University

This document is available in alternative format to

individuals with disabilities by calling the

McNair Achievement Program at 507-389-1188 (V),

800-627-3529 or 711 (MRS/TTY)

Revised 7/24/07

RONALD E. McNAIR POSTBACCALAUREATE ACHIEVEMENT PROGRAM

PART A:

Name: Tech ID#:

Last First M.I.

Proposed Graduate Field of Study: Circle one: Sophomore Junior Senior

Name of Evaluator: Institution:

I agree that the recommendation I am requesting shall be held in confidence and I hereby waive any rights I may have to examine it. yes no

PART B:

Attributes/Skills

Below Average

Above Average

Exceptional

Outstanding

Unable to Judge

Intellectual Ability

Research Aptitude

Motivation/Initiative

Oral Expression

The Ronald E. McNair Postbaccalaureate Achievement Program prepares first-generation, low-income,

and underrepresented juniors and seniors for doctoral studies, through workshops, seminars, lectures,

and summer research activity. Your assessment of the applicant’s personality, character, motivation

level, capabilities, deficiencies, and aptitude for doctoral study and promise as a professional will assist

the program in selecting the best and most deserving participants.

How long and in what capacity have you known the applicant?

Please rate the applicant’s promise as a graduate student in comparison with others of similar age and experience.