McNair Scholars Program Central Michigan University

Prospective Scholar Data Form

If you are interested in the McNair Scholars Program and would like more information, please fill in this form. We will be happy to contact you.

Date:
First name:
Last name:

 Contact Information
Local address (Street/P.O. Box):
City, State, ZIP:
Local phone number:
Primary email:
Cell phone number:

 Academic Information
Class: Freshman     Sophomore     Junior     Senior
Major(s):
Minor(s):
Expected Date of Graduation:
Educational/career goals upon completion of your undergraduate education:

 Eligibility Criteria
Ethnicity: African American
Native American
Hispanic
Native Hawaiian/Alaskan
Are you a first generation college student (i.e. the first in your family to attend college)? Yes    No
Income status (submit your parent’s TAXABLE INCOME from their most recent federal tax form, located on line number 40) [OPTIONAL]:
Number of household individuals:
GPA (must be at least 2.80):
How did you learn about the McNair Scholars Program? Letter
Email
Phone
Other 
Comments/Questions:

    
 
Form last updated September 2007