North Carolina Central University-McN-Application Form

North Carolina Central University McNair Scholars Program

Please certify that, to the best of your knowledge, you meet the minimum eligibility requirements to apply for the Ronald E. McNair Scholars Program

Please check ALL the boxes that apply to you:

Interested in obtaining a PhD or EdD Completedat least 60 hours (junior or senior status)GPA of at least 3.0Either : 1) a low-income and first-generation college student. Or: 2) underrepresented in higher education (member of a minority population)Either a citizen or permanent resident of the United States.Enrolled at NCCUAvailable to do full time research for at least one summer during program involvement, preferably during sophomore or junior year.

Applicant Contact Information

Full Name*

First NameMiddle NameLast Name

Email*

example@example.com

Local Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

City of Birth

State of Birth

Date of Birth

mm-dd-yyyy

NCCU Student Number (820#):

Sex (as self-identified)

North Carolina Central University McNair Scholars Program is responsible for tracking students until they attain their Ph.D/Ed.D

Please list contact information of at least one family members who are not included in this application

Full Name:

First NameMiddle NameLast Name

Relationship to Applicant:

Email Address:

Phone Number

(999)999-9999

Ethnic Demographic

Required: Are you of Latino or Hispanic Ethnicity

YesNo

(According to Federal McNair Guidelines, Hispanic/Latino refers to a person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin, regardless of race. As such, every Hispanic/Latino person has an associated race(s) as noted below)

Required: Race Reporting-Check all that apply (at least one)

Definitions:

1. American Indian/Alaskan Native refers to a person having origins in any of the peoples of North and South America, including Central America, and who maintains tribal affiliation or community attachment.

2. Asian refers to a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

3. Black or American of African descent refers to a person having origins in any of the black racial groups of Africa.

4. White or American of European descent refers to a person having origins in any of the peoples of Europe, the Middle East, or North Africa.

5. Native Hawaiian or other Pacific Islander refers to a person having origins in Hawaii, or the Federal States of Micronesia or Palau also known as the "freely Associated States."

For financial aid purposes, are you considered dependent or independent?

If you are a dependent student, please complete Section A. If you are an independent student, please complete Section B.

Family Demographics

Section A: Dependent Students

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

Did your parent(s) file a federal tax return for 2021?

YesNo

If yes, what was their 2020 taxable income?(Line 43 on 1040; line 27 on form 1040A; line 6 on form 1040EZ) If no, place a "0" on the line for taxable income.

Please attach: 1) A copy of your parents' 2020 federal income tax form, or

2) A copy of your most recent SAR or FAFSA

Section B: Independent Students

What is the size of your household, including yourself,your spouse, and/orother dependents?

Did you file a federal tax return for 2021?

YesNo

If yes, what was their 2020 taxable income? (Line 43 on 1040; line 27 on form 1040A; line 6 on form 1040EZ) If no, place a "0" on the line for taxable income.

Please attach: Parent(s) or Legal Guardian(s) federal tax return or FAFSA.

Education attainment of Mother

Highest Grade Completed

College degree earned, if any

Bachelor'sMaster'sDoctorate

Education attainment of Father

Highest Grade Completed

College degree earned, if any

Bachelor'sMaster'sDoctorate

With whom did you regularly reside and from whom did you receive support before the age of 18?

Mother onlyFather onlyBothOther

My signature below indicates that, to the best of my knowledge, the information given in this application is true, complete, and accurate.*

Today's date

mm-dd-yyyy

Educational Information

Number of hours completed after Fall semester 2021?

Projected graduation date (Semester & Year)

Have you taken a Research Methods course in your major?

YesNo

If not, do you plan to take a research methods course in Spring 2021?

YesNo

Current major

Minors and/or Concentrations

Major advisor

Cumulative NCCU GPA

If you are a Transfer student: Please enter your Transfer GPA

Transfer School Name

What is your projected date of entrance into graduate school?

In what field do you wish to pursue a Ph.D. degree?

Faculty Mentor Information

Provide the names and departments of two NCCU faculty members who you believe would be ideal mentors for your research internship. NOT REQUIRED- we will assist you in picking a faculty mentor.

Mentor 1

First NameMiddle NameLast Name

Mentor 2

First NameMiddle NameLast Name

Have you discussed this project with either or both professors?

YesNo

Letters of Recommendation

We require two letters of recommendation from faculty; please use the faculty recommendation forms found on the NCCU McNair Scholars Program website. Keep in mind that the letters of recommendation are significant elements of your application. IF YOU CANNOT SECURE ANY LETTERS OF RECOOMEDATION, YOU CAN STILL COMPLETE THE APPLICATION AND A MCNAIR STAFF MEMBER WILL CONTACT YOU. NOT SUBMITTING A RECOMMEDDATION LETTER WILL NOT EXCLUDE YOU FROM BEING PART OF THE PROGRAM.

1. Recommender's Name

PrefixFirst NameLast Name

1. Department

2. Recommender's Name

PrefixFirst NameMiddle NameLast Name

2. Department

My signature below indicates that, to the best of my knowledge, the information given in this application is true, complete, and accurate.

Signature*

Date

mm-dd-yyyy

Upon submission of the application, you will be emailed a prompt for the statement of purpose. This part of the application is essential and vital to turning in a completed application.

Please take your time and answer the prompts to the best of your ability.