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The Ronald E. Mcnair Scholars Program: Indiana University Bloomington

The Ronald E. McNair Scholars Program at Indiana University Bloomington is accepting applications with a deadline of January 15, 2010. The application requests information such as the applicant's name, address, citizenship status, educational background, family financial information, and parents' education levels. If selected, scholars will receive support for graduate studies and research preparation to encourage enrollment in doctoral programs.

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Ibrahim Khan
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43 views

The Ronald E. Mcnair Scholars Program: Indiana University Bloomington

The Ronald E. McNair Scholars Program at Indiana University Bloomington is accepting applications with a deadline of January 15, 2010. The application requests information such as the applicant's name, address, citizenship status, educational background, family financial information, and parents' education levels. If selected, scholars will receive support for graduate studies and research preparation to encourage enrollment in doctoral programs.

Uploaded by

Ibrahim Khan
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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The Ronald E.

McNair Scholars Program


Indiana University Bloomington
University Graduate School
803 E. 8th Street
Bloomington, IN 47408
(812) 855-4005

Deadline for Application: Friday, January 15, 2010


Statement of Confidentiality: The information contained in this application is for the purpose of
determining the applicants eligibility for the McNair Scholars Program and will be held in
confidence.
(Please type or print legibly in ink)
I.
APPLICANT INFORMATION
Name: __________________________________________________ I.D. #_______________
Last

First

MI

Local Address: ____________________________________________________________________________


Street

____________________________________________________________________________
City

State

Zip

Local Telephone: ________________________________________


(Area Code)

Number

Home Address: ____________________________________________________________________________


Street

____________________________________________________________________________
City

State

Home Telephone: ________________________


(Area Code)

Zip

Date of Birth: ____________________

Number

Month / Day / Year

Preferred Electronic Mail Address: _____________________________________________________________


Gender:

Male

____

Female ____

Citizenship:

U.S. Citizen _______ Permanent Resident ________

Other: __________________________________

Ethnicity or Race: ___________________________________________________________

II. EDUCATIONAL INFORMATION:


Class Standing:

freshman: ____ hours earned


junior: ____ hours earned

Major: _________________________________

sophomore: ____ hours earned


senior: ____ hours earned

Minor: ________________________

Projected Graduation Date: _________________________________


Month

Year

Academic Advisor: ____________________________________________________________


Name

_____________________________________________________________
Campus Address
_________________________________________________________________________
Campus Telephone
Email Address

I have previously participated in: ____


____
____
____
____
____
____
____

Upward Bound
Talent Search
Groups (Student Support Services)
EOC
Hudson/Holland Scholarship Program
STARS
FASE Mentoring Program
21st Century Scholars Program

Academic and extracurricular awards, honors, and scholarships:

Membership or participation in academic/campus organizations and activities:

Previous research experience (include name of program, institution, year, and faculty mentor):

Page 2

III. FAMILY INFORMATION


For financial aid purposes, are you considered: ____ Dependent
____ Independent
If dependent, complete the questions below in Section A.
If independent, skip to Section B.

Section A
What is the size of your parents household, including yourself and your parents?
____________
Did your parents file a federal income tax return for 2008? ____ Yes

____ No

If yes, what was their 2008 taxable income? $_____________________________


(IRS Form 1040: Line 43; IRS Form 1040A: Line 27; IRS Form 1040EZ: Line 6)
If your answer is no, place a 0 on the line above for taxable income.

If independent, complete the questions below in Section B.

Section B
What is the size of your household, including yourself, spouse, and/or other
dependents? ______
Did you file a federal income tax return for 2008?

____ Yes

____ No

If yes, what was your 2008 taxable income? $ _____________________________


(IRS Form 1040: Line 43; IRS Form 1040A: Line 27; IRS Form 1040EZ: Line 6)
If your

If your answer is no, place an 0 on the line above for taxable income.

IMPORTANT: For purposes of documentation, please attach a photocopy of the 2008 federal
tax form that was filed.

Page 3

Do you or your family receive assistance from any of the following sources?
Yes
Aid to Families with Dependent Children (AFDC)
Social Security
Veterans Benefits
Food Stamps
Unemployment Compensation
Other ________________________________________

No
____
____
____
____
____
____

____
____
____

____
____
____

Please specify

Are you currently receiving financial aid?

____ Yes

____ No

IMPORTANT: If yes, please attach a copy of your most recent Student Aid Report
(SAR), Free Application for Financial Student Assistance (FAFSA), or your IUB financial
aid transcript.
Are you currently employed?

____ Yes

____ No

If yes, how many hours per week do you work? _________


Place of Employment and phone # __________________________________________
Supervisors Name: ______________________________________________________

Education Attainment of Mother:


Highest Grade Completed: 1

10

11

12

13

14

15

16

Please circle appropriate response

College Degree earned (if any):

____ Bachelor

____ Masters

____ Doctorate

Education Attainment of Father:


Highest Grade Completed: 1

10

11

12

13

14

15

Please circle appropriate response

College Degree earned (if any):

____ Bachelor

Page 4

____ Masters

____ Doctorate

16

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