McNair Scholars Program Central Michigan University

Graduated Scholar Information Update Form

Thank you for keeping the the McNair Program updated!

Contact Information
Date:
Full name:
Maiden name (if different than above):
Current address:
City, State, ZIP:
Phone:
Cell:
Email:
Work phone:
   
Permanent or parental address (if different than above):
Address:
City, State, ZIP:
Phone:
   
Please list two other sources through whom we may contact you:
Source 1:  
Name:
Address:
City, State, ZIP:
Email:
Phone:
Relationship:
Source 2:  
Name:
Address:
City, State, ZIP:
Email:
Phone:
Relationship:

 

Educational Information
Degree(s) completed: Bachelor's
Master's
Doctoral
Other: 
Current enrollment: Bachelor's
Master's
Doctoral
Other: 
Indicate year in current program: First
Second
Third
Other: 
   
Please list all post-baccalaureate institutions attended:
Institution 1
Major
Research interest:
Graduation date:
Degree received: (ex. M.S. in Biology)
   
Institution 2
Major:
Research interest:
Graduation date:
Degree received: (ex. M.S. in Biology)
   
Institution 3
Major:
Research interest:
Graduation date:
Degree received: (ex. M.S. in Biology)
   
Yes     No  Were you able to secure adequate funding to continue your education?
Please explain:

 

Future Educational Goals
Do you anticipate pursuing further education? If so, when and in what area?
If you are not currently enrolled, please explain why:

 

Employment
Employer:
Location (City, State):
Job title:
Status: full time
part time
temporary
Briefly describe your job responsibilities:

 

Miscellaneous
Awards/honors received:
Organizations/activities
Personal updates:

 

Yes     No  Can we post your enrollment in a degree program along with your email address as a point of contact for other scholars in future editions of the McNair newsletter and website?

 

    
   
Form last updated October 2006