First Name : M.I. : Last Name : WesID : Class Year : --Choose One-- --Choose One--2020 2019 2018 2017 Email : Wesleyan PO Box : Address : City : State : Zip : Cell Phone : Birth Month : --Choose One-- --Choose One--Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Birth Date : --Choose One-- --Choose One--1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Birth Year : --Choose One-- --Choose One--1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 Gender : Citizenship Status : --Choose One-- --Choose One--Citizen Permanent Resident Neither If Permanent Resident, please provide Alien # : Which best describes your background? : --Choose One-- --Choose One--African-American Asian Hispanic/Latino Native Hawaiian/ Pacific Islander Native American/Alaskan Native Caucasian Other If Other, please specify : Did either parent complete a bachelor's degree; or did the parent with whom you resided and from whom you received support (up to age 19) receive a bachelor's degree? : Father's (Guardian's) Name : Father's Phone : Father's last completed grade or degree : --Choose One-- --Choose One--Elementary Junior High 9 10 11 High School Degree Associate's Degree BA/BS MA/MS PhD N/A (guardian is not part of family) Mother's (Guardian's) Name : Mother's Phone : Mother's last completed grade or degree : --Choose One-- --Choose One--Elementary Junior High 9 10 11 High School Graduate Associate's Degree BA/BS MA/MS PhD N/A (guardian is not part of family) Number of people living in household : Taxable income of the household from last year income tax form : Where do I find this? line on 1040 - 43 line on 1040A - 27 line on 1040EZ - 6 if no form filed, enter no form filed 1st Major/Intended Major : 1st Advisor (if you have one) : 2nd Major/Intended Major : 2nd Advisor (if you have one) : GPA : Expected semester of graduation : Semester first enrolled at Wesleyan : Since receiving your high school diploma, have you attended any college or university other than Wesleyan? : If yes, list institution(s) and dates of enrollment : Do you have a degree beyond high school? : If yes, what type? : What degree do you plan to pursue? : If Other, please specify : Do you intend to pursue a doctoral degree? : Do you intend to pursue a professional degree? : If so, which type? : Which of the following best describes your commitment to attend graduate school? : --Choose One-- --Choose One--Thinking about grad school & exploring options. Going to grad school after working 1 or 2 yrs. Attending grad school right after earning BA. Committed to getting MA/MS, JD or MD, unsure about PhD Committed to attending grad school & completing PhD Name of first recommender : Email : Name of second recommender : Email : Research Proposal: In your own words describe your research interest/question that could potentially be the basis of your McNair research project and propose methods for implementing it. : Insert your personal statement below, answering the following questions: What are your academic and research interests? How will participation in the McNair program fit into your long-range academic and professional plans? What are your plans for attaining a doctoral degree and how is a Ph.D. essential to your pursuits? Please include any relevant research experience you may have, and other experiences you have had that will help you succeed in graduate school. [300-500 word limit] : Required Supporting Documents
Please send hard copies to:
Ronnie Hendrix
Copy of most recent signed income tax form of parent(s)/guardian(s)
Copy of financial award letter
Transcript (unofficial copy is acceptable)
References from individuals listed in Section 3
I hereby affirm that all financial and educational information listed above in this application is true and correct. I understand that any misrepresentation or false statement will make the applicant ineligible for the McNair Program. : If accepted into this program, I agree to participate in all required McNair events, and to inform the Wesleyan McNair Program of changes in my academic program or degree plans, at Wesleyan and as I progress through graduate school :
