McNair Program Interest Form

McNair Program

If you are interested in the McNair Program and would like to receive additional information please complete and submit the form below. The fields with an asterisk (*) are required.

Personal Information
*First Name
*Last Name
Middle Initial
Permanent Address
*Street
*City
*State	Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Ontario Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
*ZIP
Home Phone	() -
Work Phone	() -
E-mail
Current/Campus Address
Street
City
State	Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Ontario Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
ZIP
Phone	() -
Other Information
*Classification	Freshman Sophomore Junior Senior
*Major	Biology Chemistry Chemistry and Engineering Computer Science Criminal Justice Early Childhood Education English Elementary Education General Science (Biology Emphasis) General Science (Chemistry Emphasis) General Science and Engineering Global Studies Liberal Arts Management Science Mathematics Mathematics and Engineering Nursing Pre-Dental/General Science Pre-Pharmacy/General Science Pre-Physical Therapy Psychology Social Science Social Work Special Education Urban Arts Production Undecided
*What is your GPA?
Out of 4.0
*Do you own a personal computer or laptop?
Yes No
*Do you expect to persue a Phd immediately after earning a masters degree?
Yes No
*Did your mother/guardian receive a bachelor's degree?
Yes No
*Did your father/guardian receive a bachelor's degree?
Yes No