Application Requirement Checklist (Please check these boxes off once you enclose each item with your application)

Transcription

1 Ronald E. McNair Scholars Program 204 Park Shops, Campus Box 7105, Raleigh, NC Phone (919) Fax (919) Application Requirement Checklist (Please check these boxes off once you enclose each item with your application) Completed and Signed Application (Check Only if Completed and Signed Application ) Completed Personal Statement Résumé Two Completed Recommendation Forms: - Recommendation Form No. 1 MUST be from a faculty member - Recommendation Form No. 2 May be from an Academic Advisor, Faculty member or other university official. Recommendation forms can be enclosed in the application in a sealed envelope or mailed to the McNair Scholars office (Park Shops 204, Campus Box 7105, Raleigh, NC 27695) Signed Information Release Form Indicate ability to attend an interview during winter break: Yes No Date: My signature and check box indicates below that, to the best of my knowledge, the information given on this application is true, complete, and accurate. Signature Date 1

2 PROGRAM APPLICATION The Ronald E. McNair Scholars Program at the NC State is one of 161 programs at colleges and universities across the country and part of a group of federal programs known collectively as TRIO. The McNair Scholars Program helps qualified undergraduate students prepare for admission to doctoral programs and the successful pursuit of PhD degrees. Eligible students must be U.S. citizens or permanent residents who are also first-generation AND low-income OR be a member of a group traditionally underrepresented in graduate education (African-American, American Indian/Alaskan Native, Hispanic/Latino, or Pacific Islander). The Ronald E. McNair Scholars Program provides undergraduates with research experiences, GRE preparation sessions, faculty mentoring, professional skills, and assistance with the graduate school application process at no cost to the student. / / *Social Security Number Student ID Number Date of Birth First M.I. Last Current (Campus) Address City State Zip Code NC State Best phone number to be reached I identify my gender as: U.S. Citizen or Permanent Resident: Yes No If applicable, Permanent Resident # Date Issued: To which racial or ethnic group(s) do you most identify? Check all that apply. For statistical purposes only. Hispanic or Latino Asian White/Caucasian American Indian/Alaskan Native Black/African American Native Hawaiian or Islander Other: Emergency Contact Name (Parent, Guardian or Partner) Address City State Zip Code Phone Number: Relationship to you: 2

3 FIRST-GENERATION The U.S. Department of Education defines a first-generation college student as an individual who grew up in a household where neither parent/guardian completed a four-year degree before the individual turned 18. Individuals who grew up in foster care are automatically considered first-generation. Based on this definition, are you a first-generation college student? Yes No FINANCIAL ASSESSMENT Please answer the following questions by checking the appropriate response and completing the statements as it applies to your household. Documentation of Household Size and Taxable Income is required to determine financial eligibility for participation in the TRIO Ronald E. McNair Scholars Program. Did anyone in your household file federal income tax last year? Yes No Year: 20 If yes, what was the taxable income: Taxable income can be found on Line 6 on 1040EZ / Line 27 on 1040A / Line 43 on *Application cannot be processed without taxable income; it may be zero. Total Number in Household: Read the following statement and sign: My signature certifies that the above information is correct. I understand that this information is confidential and will only be used for income verification for this program. Student Signature Date Parent/Guardian Signature (if student is a dependent) Date ACADEMIC INFORMATION College or Department at NC State (ex. CHASS, PCOM, UC, COE, etc.) Academic Advisor Major(s) Minor(s) How did you hear about the TRIO McNair Scholars Program? Current Classification (based on hours completed or transfer hours to NC State): Freshman (0-29 credit hours) Junior (60-91 credit hours) Sophomore (30-59 credit hours) Senior (92 or more) Cumulative GPA Last Semester GPA Expected Month/Year of Graduation from NC State (mm/yy) Are you eligible for financial aid at NC State? Yes No Do you qualify for and/or receive the Pell Grant? Yes No 3

4 Are you a Pack Promise Scholar? Yes No Academic or Professional Honors -List honors you have earned since beginning college (e.g., undergraduate scholarships, academic or professional honors, research awards, and honor societies). Have you previously participated in any of the following programs? Upward Bound/Upward Bound Math & Science/Veterans Upward Bound Yes No Talent Search Yes No GEAR Up Yes No Student Support Services/Student Support Services STEM Yes No At what school(s)? NEEDS SELF-ASSESSMENT Please check all of the services on the list provided below that you feel you need most in your pursuit of a doctorate degree: Graduate School Preparation GRE Preparation Writing Personal Statement Connecting with Graduate Schools/Faculty Strategies for Success in Graduate School Selecting Graduate Programs with best fit Graduate School Admissions Process Fellowships/Funding for Graduate School Summer Research Opportunities Research Skills Technical Writing Skills Library Research Skills Selecting a Research Topic Defining your Research Question Writing an Annotated Bibliography Writing a Literature Review Presenting Your Research Thriving in College Tutoring - Course(s) Financial Aid Advising/Funding Critical Thinking Skills Career Awareness/Exploration Networking/Professionalism Interpersonal/Communication Stress Management Time-Management and Goal Setting Building Relationships with Faculty Selecting a Faculty Mentor Scholarships EDUCATIONAL INTEREST Anticipated Field of Doctoral Study: Graduate Programs you are interested in visiting: Potential Faculty Mentor(s) Information: Name Dept. * The Ronald E. McNair Scholars Program cannot guarantee that students will work with the faculty member listed above. The information provided will be used in assisting to find a suitable mentor. 4

5 Please mark all statements below that best describe your interest in graduate education: I am thinking about graduate school and would like to explore my options. I intend to go to graduate school after working one or two years, or after Fulbright/AmeriCorps. I plan to attend graduate school immediately after receiving my Bachelor s degree, depending on the amount of financial assistance I receive. I plan to attend graduate school immediately after receiving my Bachelor s with or without funding. I am determined to get a Master s degree, but I am not certain about a Ph.D. I am determined to get a Ph.D. PERSONAL STATEMENT Please attach your personal statement including a response to each of the questions from the following three prompts below. Please make sure to answer all parts of each question. Your personal statement should be no more than two pages, typed (12 pt. font) and double spaced. Prompt 1: Tell us your story (your family background, journey to college, challenges you have faced and overcome, etc.). How has your personal background prepared you for the rigors of the Ronald E. McNair Scholars Program as well as doctoral study? Prompt 2: Explain your reasons for pursuing a doctoral degree. If selected to be a McNair Scholar, what research topic(s) would you be interested in researching and how is this research related to your educational/career goals? How will the Ronald E. McNair Scholars Program assist you in making your educational/career goals possible? Please specify your projected timetable for obtaining the Ph.D. Prompt 3: The NC State Ronald E. McNair Program summer research experience is intense, stimulating, and challenging. Participants will learn a lot with special emphasis on completing a research project from start to finish and how to apply to, get accepted to, and succeed in graduate school. What concerns do you have about succeeding in NC State s McNair Summer Research Program? What do you hope to gain from the experience? RECOMMENDATIONS List the names and addresses of at least two individuals who have agreed to submit a recommendation form on your behalf. To be considered complete, your application MUST have two recommendation forms, but no more than three. At least one recommendation MUST come from a faculty member at a college or university. Recommenders should complete either the attached Faculty/Staff Recommendation Form or the online version available at go.ncsu.edu/mspform. Name: Name: Name:

6 NC State University TRIO McNair Scholars Program Release of Information I,, authorize NC State University TRIO Collegiate Programs (Student Support Services, Student Support Services-STEM and Ronald E. McNair Scholars Programs) to gather information concerning my academic progress (mid-semester progress reports, standardized test scores, grade point average, earned credits, transcripts) and financial aid information prior to my participation and throughout my involvement in the Ronald E. McNair Scholars Program. I understand that this information is used to assist in the determination of my eligibility for the TRIO Collegiate Programs and it will be held strictly confidential. I am aware that my eligibility, participation and financial aid status will be reported to the U.S. Department of Education in accordance with the grant funding regulations. I certify that the information provided on this application is true and complete to the best of my knowledge. I also agree to provide documentation upon request to verify the information reported. I am aware that the personal information that is provided to the TRIO Collegiate Programs will be protected under the Family Education Rights Privacy Act of No one will have access to the information unless they work with or for the NC State TRIO Programs or they are specifically authorized by me to see the information. I understand NC State Ronald E. McNair Staff and Advisory Board Members will have access to and will protect the confidentiality of my materials related to this application and my participation in the program. Upon formal acceptance into the program, I grant permission for program representatives to have access to my official academic and financial records in order to assist and provide services. Additionally, in the course of my involvement in the Ronald E. McNair Scholars Program, TRIO staff may consult with various NC State University offices and programs to secure and share the necessary information pertinent to my participation in the program and overall collegiate success. Finally, I give my permission to use photographs, quotes, and statements and/or print my first and last name in any and/or all publications for the Ronald E. McNair Scholars Program. Signature Date Parent Signature (for applicants under the age of 18) 6

7 Faculty/Staff Recommendation Form This section to be completed by the applicant. Please print or type. Applicant - With the exception of the contents of this box, this form should be completed by your recommender and returned to you in a sealed envelope for inclusion in your application packet. Last Name First Name Middle Initial I hereby waive any right to examine this letter of recommendation. I realize that the NC State McNair Scholars Program will utilize this recommendation only in conjunction with consideration of my admission to the McNair Scholars program. I realize my right of access to this recommendation is not a condition of my admission. Signature Date About the McNair Scholars Program Part of the federally funded TRIO programs, the McNair Program is designed to encourage low- income, firstgeneration college students and students from groups currently underrepresented in graduate education to pursue a doctoral degree in their chosen field. The McNair Program is named in honor of Dr. Ronald E. McNair, one of seven crew members aboard the Space Shuttle Challenger. Despite social and economic barriers, Dr. McNair earned many outstanding achievements such as completing a Ph.D. in Physics from M.I.T. at the age of 26 and was the second African-American to fly in space. In addition, Dr. McNair received many distinguished awards, including the National Ford Foundation Fellowship and the Presidential Scholarship. The McNair Scholars Program at NC State is one of 161 programs at colleges and universities across the country and part of a group of federal programs known collectively as TRIO. The McNair Scholars Program helps qualified undergraduate students prepare for admission to doctoral programs and the successful pursuit of PhD degrees. The McNair Scholars Program provides undergraduates with critical research experiences, GRE preparation sessions, faculty mentoring, professional skills, and assistance with the graduate school application process at no cost to the student. Participants are required to be engaged in academic research. 1

8 To the Recommender: Thank you for assisting the applicant with his/her McNair Scholars Program application. In order to ensure accurate evaluation of the applicant, we request that you complete this form in confidence and return it to the requester in a sealed envelope. The requester will include it as part of her/his application packet. If it is more convenient, you may submit this form directly to our office. Please return this form directly to the student or to the McNair Scholars Program office in a sealed envelope with your signature over the seal. TRIO McNair Scholars Program Park Shops 204 Campus Box 7105 Raleigh, NC trio-mcnair@ncsu.edu 1. How long have you known the applicant and in what capacity? (Give dates, if possible.) 2. (For instructors of applicants only.) I would rank this applicant in the top % of the approximately undergraduate students I have taught with the last five years. 3. Please rate the applicant in each attribute/skill listed below compared to other students with whom you have worked. Attributes/Abilities Rating Intellectual Potential Critical Thinking Research Ability Oral Expression Written Expression Open-mindedness Creativity Flexibility Dependability Motivation/Initiative Emotional Maturity Motivation for the pursuit of advanced graduate study Present academic performance in area of concentration 2

9 4. What are the applicant s greatest strengths and weaknesses with regard to academics, research ability or other characteristics relative to academic success? 5. What is your assessment of this applicant s writing ability? Excellent Above Average Average Poor Have not observed 6. Please provide any additional comments and/or assessment of the applicant s potential for success in graduate school. We will appreciate your candid appraisal. 7. Recommendation concerning selection for the program (check one): I recommend the applicant with confidence. I recommend the applicant I recommend the applicant with reservation. I do not recommend the applicant. Evaluator s Signature: Print Name: Position/Title and Department: Phone: Date: 3