McNAIR POST BACCA LAUREATE ACHIEVEMENT PROGRAM APPLICATION

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1 McNAIR POST BACCA LAUREATE ACHIEVEMENT PROGRAM APPLICATION PERSONAL INFORMATION SCHOOL ID APPLICATION DATE FULL LEGAL NAME LAST FIRST MIDDLE PERMANENT ADDRESS CURRENT ADDRESS CITY/STATE/ZIP CITY/STATE/ZIP COUNTRY COUNTY (NJ RESIDENTS ONLY) COUNTRY COUNTY (NJ RESIDENTS ONLY) LOCAL OR CAMPUS PHONE WORK PHONE CELL PHONE ADDRESS GENDER MALE FEMALE DATE OF BIRTH (MM/DD/YY) MARITAL STATUS ETHNIC BACKGROUND: Federal law requires the College to report the ethnicity of all U.S. citizens and resident aliens in the following five categories; please circle one: Black or African/ non Hispanic Hispanic/Latino Native Hawaiian/Pacific Islander American Indian or Native Alaskan White/Non Hispanic Asian Other NATION OF CITIZENSHIP COUNTRY OF BIRTH If you are not a United States citizen but have United States permanent residency status, you must give your alien registration card number: 1 P a g e

2 EDUCATIONAL INFORMATION Current Major(s): What degree are you seeking (i.e., B.A., B.S.): Expected date of graduation: Expected field of graduate study: Highest degree sought: Current Cumulative GPA: Current GPA in major: Total credits completed (be as current as possible): Current Classification (please check): Freshman Sophomore Junior Senior What date did you first enroll in a program of postsecondary education: Please indicate if you are one of the following (please check all that applies): Honor Student SAGE EOF STAR Former Trio Student Yes No If yes, what TRIO program Check 2 3 areas of study that are of interest to you (see specific majors in the appendices of the application package): Physical Science Life Sciences Engineering Health Sciences Nursing Social Sciences Humanities Education Business Administration Medicine, Dentistry, and Other Medical Fields Law 2 P a g e

3 FINANCIAL INFORMATION Are you currently eligible to receive financial aid (Please check)? Yes No Do you receive a Pell Grant? Yes No With regard to the University financial aid office, what is/would be your status (Please circle)? Dependent Independent If Dependent status, please complete Box A below; if Independent status, please complete Box B below: Box A Dependent status What is the size of your parent s household including yourself and/or other dependents? Did your parents file an income tax return last year (circle one)? Yes No If yes, what was their most current taxable income? Box B Independent status What is the size of your household including yourself, spouse and/or other dependents? Did your parents file an income tax return last year (circle one)? Yes No If yes, what was your most current taxable income? FAMILY BACKGROUND With whom do you maintain permanent residence (CHECK ONE)? Mother Father Two Parents Self Supporting Were you claimed on your parent s tax return as a dependent? Yes No Did your mother graduate with a Bachelors Degree? Yes No Did your father graduate with a Bachelors Degree? Yes No Did your legal guardian graduate with a Bachelors Degree? Yes No 3 P a g e

4 FOLLOW UP CONTACT INFORMATION STUDENT NAME SSN# Name of Relative/Permanent Contact Relationship: Mailing Address /Street City State Zip Code Telephone ( ) Does your Relative/Permanent Contact speak a language other than English as a first or only language? If so, list her/his primary language here: Name of Relative/Permanent Contact Relationship: Mailing Address /Street City State Zip Code Telephone ( ) Does your Relative/Permanent Contact speak a language other than English as a first or only language? If so, list her/his primary language here: Name of Relative/Permanent Contact Relationship: Mailing Address /Street City State Zip Code Telephone ( ) 4 P a g e Does your Relative/Permanent Contact speak a language other than English as a first or only language? If so, list her/his primary language here:

5 By signing this application, you agree that all of the information provided is correct to the best of your knowledge. Your signature also grants your permission for the Bloomfield College McNair Scholars Program to solicit further information as needed from campus departments such as the Office of Financial Aid and Scholarships, Admissions, and the University Registrar. This information will be kept confidential and will be used only for purposes related to your application to the Bloomfield College McNair Scholars Program. Applicants' Signature: Date: Please return completed application materials to: Dr. Anthony Salandy McNair Program Learning Resource Center Bloomfield College 467 Franklin Street Bloomfield, NJ If you have questions or require additional information, please call Ext P a g e

6 Bloomfield College McNair Scholars Program Recommendation Form Applicant s Name: Address: Telephone: This section is to be completed by a faculty member, who is familiar with your academic abilities, and returned by the recommender directly to the McNair Scholars Program as soon as possible. To the recommender: The McNair Scholars Program is designed to prepare selected Bloomfield College undergraduates for graduate study in a Ph.D. program. The students spend two academic years developing writing and research skills while they plan a research project conducted under the mentorship of a faculty member. Part I. Please attach to this form a statement about the applicant. In your letter, we would like you to answer the following questions: How long have you known the applicant and in what capacity? What is your appraisal of the applicant s promise as a graduate student and future scholar? 6 P a g e

7 PART II. Evaluate the applicant s academic aptitude and preparation for graduate work, motivation for the pursuit of advanced graduate study, and present academic performance in area of concentration. The above named student is applying to the McNair Scholars Program. On the scale below, please rate the applicant s abilities. 5 = Outstanding 4 = Excellent 3 = Good 2 = Average 1 = No Opinion Leadership Ability Initiative Self Discipline Present Academic Integrity Creativity Maturity Academic Aptitude and Potential for Graduate Work Performance in Area of Concentration Motivation for the Proposed Program of Study Signature: Date: Name: Title: Address: Please return this form via inter campus mail to the McNair Scholars Program, Learning Resource Center Bloomfield College, 467 Franklin Street, Bloomfield, NJ If you have any questions, please contact Dr. Anthony Salandy at Ext. 662 or at 7 P a g e

8 LIST OF MAJORS Physical Sciences include: Astronomy, Atmospheric Sciences and Meteorology, Chemistry, Computer Sciences, Earth Sciences, Environmental Sciences, Geology, Information Sciences, Marine Sciences (including Oceanography), Mathematics (including Mathematical Statistics, Operations Research), Physics Engineering includes: Aerospace, Biomedical, Civil, Chemical, Computer, Electrical and Electronics, Engineering Technology, Industrial and Manufacturing, Mechanical, Metallurgical and Material, Mining, Nuclear, Structural, Systems Life Sciences include: Agricultural Sciences, Agricultural Management, Biological Sciences (all fields), Biometrics and Biostatistics, Botany and Other Plant Sciences, Ecology, Forestry, Genetics, Horticultural Sciences, Neuroscience, Nutritional Sciences, Parasitology, Pharmacology, Physiology Human and Animal), Soil Sciences, Toxicology, Zoology Health Sciences include: Allied Health Technologies and Services, Health Sciences, Hospital Administration, Kinesiology, Nursing, Pharmacy, Public Health, Rehabilitation Services and Counseling, Speech-Language Pathology and Audiology Social Sciences include: Anthropology, Area Studies, Communications, Criminology, Demography/Population Studies, Economics/Econometrics, Geography, Journalism, International Relations/Affairs, Political Sciences and Government, Psychology (including Biopsychology), Public Policy, Sociology, Urban Studies/Planning Humanities include: American Studies, Afro-American Studies, Art and Art History, Classics and Letters, Dance, Films and other Visual Arts, English Literature and Language, Ethnic Studies, Foreign Languages and Literature, History, Home Economics, Interdisciplinary Studies, Linguistics, Music (including Performance), Philosophy, Speech and Rhetorical Studies, Theology and Religious Studies Education includes: All teaching specialty fields, Education Research, Teacher Education Business Administration includes: Accounting, Banking, Business Administration/Management, Finances, Industrial Organization, Marketing and Marketing Research, All other Business fields Medicine, Dentistry, and Other Medical Fields includes: Chiropractic, Dentistry, Medicine (all specialties), Optometry, Podiatry Law Other Professional Fields includes: Architecture, Library Sciences, Parks and Recreations, Protective Services, Social Work 8 P a g e

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