Part IV: TRANSCRIPT
By signing the agreements below, you consent to McNair personnel obtaining your ESU transcript information. If you are a transfer
student, please provide an unofficial transcript from each institution you have attended.
Part V: UNDERSTANDING, AGREEMENT, AND CONSENT
Please read and initial each statement and then provide your signature to complete your application form.
___ To the best of my knowledge, all information provided in this application is true and correct.
___ I authorize the ESU TRIO McNair Scholars Program (McNair) to access my educational records and use information as
necessary to provide services and make reports to the U.S. Department of Education. I also authorize McNair to obtain reports
from my instructors regarding academic progress and the National Student Clearinghouse regarding enrollment and degree
information. I understand that all information will be kept confidential and used for the purposes of needs assessment, program
evaluation, federal reporting, and other administrative purposes. I understand that I will have access to all of my records
excluding letters of recommendation and mentor evaluations to which I have waived my right to access.
___ I recognize that, by federal law, the McNair Scholars Program must verify income-based eligibility and may contact the Office of
Financial Aid to verify dependency status. Further, I acknowledge that forms completed electronically requiring a parent’s
signature [for dependent students only] may require confirmation. I am providing the following email address that belongs to my
parent, ________________________________, for confirmation purposes only: _____________________________________.
parent name parent email address
___ I grant McNair permission to use photographs, video, quotes, academic accomplishments, statements, and/or my first and last
name in any/all McNair publications and electronic media.
___ I understand that some services offered by the McNair Scholars Program are required; these services include at least one
Honors Contract Course annually, participation in a Summer Research Internship, and advising each semester by my Faculty
Mentor and the McNair Scholars Program personnel. If selected as a Scholar, I will adhere to all requirements and strive to meet
all goals set forth in my individualized McNair Academic and Scholarly Achievement Plan through additional individual and group
services offered by the McNair Scholars Program.
___ I hereby release and hold blameless the State of Kansas, Kansas Board of Regents, Emporia State University, and their
employees from any and all claims and liabilities of any type whatsoever and for injury to or death which may now or hereafter
arise out of result from or be in any way connected directly or indirectly with the McNair Scholars Program and its activities.
I have read, agree with, and consent to these statements.
Student Signature Date