McNair Scholar Alumni Form

Section 1: Scholar Information

Name (First, Last):
Maiden Name (If Different when enrolled in program):
Home Address:    Email:
City     State   Zip:
Home Phone:      Work Phone:           Ethnicity:      [select ethnicity] American Indian Alaskan Native Native Hawaiian Hispanic or Latino White Black Asian Other Pacific Islander Other
Date you completed your undergraduate degree: Term: [select term] Spring Fall      Year:
If you have not recieved your BA, why: [select why] Applied but not Admitted Did not apply or denied offers for financial reasons Did not apply or denied offers for health reason Did not apply or denied offers for other reasons Withdrew from program for academic reasons Withdrew from program for financial reasons Withdrew from program for health reasons Withdrew from program for personal reasons Called for military duty Other
Department of study when enrolled:
Major of study when enrolled:

Section 2: Graduate School Information

I am currently/planning to enroll at (name of instituition):
Location of Instituition: City:      State:
Major of study when enrolled:
I am currently/planning to work on: JD      CRED      Masters      MD      PhD      PhD/MD
I expect to graduate on: Term: [select term] Spring Fall      Year:
This will be my: 1st Year  2nd Year  3rd Year  Working on Thesis  Working on Dissertation

Section 3: Other Information

Additional comments or suggestions: