Fillable Ronald E. McNair Post-Baccalaureate Achievement Program (North Carolina State University)

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Ronald E. McNair Post-Baccalaureate Achievement Program (North Carolina State University)

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204 Park Shops, Campus Box 7105, Raleigh, NC 27695 | Phone (919) 513.7774 | Fax (919) 513.7542
https://trio.dasa.ncsu.edu/mcnair-scholars-program/
1
Ronald E. McNair Post-Baccalaureate Achievement Program
Am I eligible for the McNair Scholars Program?
The Ronald E. McNair Post-Baccalaureate Achievement Program is a federally funded TRIO program sponsored by the
U.S. Department of Education. This form is provided to determine your eligibility before applying. To be eligible, TRIO
Ronald E. McNair Scholars must be first-generation and meet income requirements based on U.S. Department of Education
federal guidelines (taxable income) or be a member of a group traditionally underrepresented in graduate education.
(African-American, American Indian/Alaskan Native, Hispanic/Latino, or Pacific Islander).
Please check all of the following provisions that apply to you:
Yes
No
I am a U.S. citizen or permanent resident.
☐
☐
I am a member of a racial or ethnic group that is traditionally underrepresented in graduate
education: Alaska Native, American Indian, Black/African American, Hispanic, Native Hawaiian, or
Native Pacific Islander.
☐
☐
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?
☐
☐
I meet the Federal TRIO Programs low income guidelines (my family’s taxable income is at or
below the limits in the table on the next page).*
Did anyone in your household file federal income tax last year? ☐Yes ☐ No Year: 20_____
If yes, what was the taxable income: ______________ (Line 11B on 1040)
Total Number in Household: ______________
*Taxable income is located on line 11b on 1040
☐
☐
Are you eligible for financial aid at NC State?
☐
☐
Do you qualify for and/or receive the Pell Grant?
☐
☐
I am available to do full time research for at least one summer during program involvement?
☐
☐
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 Signature (If you received support from parent(s) or guardian) Date
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204 Park Shops, Campus Box 7105, Raleigh, NC 27695 | Phone (919) 513.7774 | Fax (919) 513.7542
https://trio.dasa.ncsu.edu/mcnair-scholars-program/
2
Federal TRIO Programs Current Year Low-Income Levels: Taxable Income
(Effective January 15, 2020 until further notice)
Size of Family Unit
48 Contiguous States,
D.C., and Outlying Jurisdictions
Hawaii
1
$19,140
$22,020
2
$25,860
$29,745
3
$32,580
$37,470
4
$39,300
$45,195
5
$46,020
$52,920
6
$52,740
$60, 645
7
$59,460
$68,370
8
$66,180
$76, 095
For family units with more than eight members, add the following amount for each additional family member: $6,720 for the
48 contiguous states, the District of Columbia, and outlying jurisdictions; $8,400 for Alaska; and $7,725 for Hawaii.
* In order to be income eligible, your family's taxable income must be at or below the limits listed above.
Note: Selection will be made on a competitive basis from those applicants who best meet the purposes of the program as
defined by the U.S. Department of Education. Specifically, 2/3 of the individuals participating in the McNair Program must
be low-income and first-generation college students. The remaining 1/3 may be from one of the following underrepresented
groups in doctoral study: African American, Hispanic/Latino, Native American, Hawaiian or Pacific Islander. Applicants who
best meet the federally mandated guidelines will be selected on the basis of their potential for pursuing doctoral studies and
their ability to benefit from the program.
204 Park Shops, Campus Box 7105, Raleigh, NC 27695 | Phone (919) 513.7774 | Fax (919) 513.7542
https://trio.dasa.ncsu.edu/mcnair-scholars-program/
3
2020-2021 PROGRAM APPLICATION
The McNair Scholars Program at NC State is one of 187 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 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.
____________________ _____/______/______
Student ID Number Date of Birth
___________________________________ _________ ___________________________________
First M.I. Last
_________________________________________ _______________________ ______ __________
Current (Campus) Address City State Zip Code
______________________________________ ___________________________
NC State Email Best phone number to be reached
I identify my gender as: _______________________ Pronoun(s): _______________________________
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
☐American Indian/Alaskan Native
☐Asian
☐Black/African American
☐White/Caucasian
☐Native Hawaiian or Islander
☐Other: __________________________
Emergency Contact:
Name (Parent, Guardian or Partner) __________________________________________________________
Address _______________________________________________________________________________
City _________________________________________ State ____________ Zip Code ________________
Phone Number:
_________________________ Relationship to you: _____________________________
204 Park Shops, Campus Box 7105, Raleigh, NC 27695 | Phone (919) 513.7774 | Fax (919) 513.7542
https://trio.dasa.ncsu.edu/mcnair-scholars-program/
4
ACADEMIC INFORMATION
College or Department at NC State
(ex. CHASS, PCOM, UC, COE, etc.)
Academic Advisor
Major(s)
Minor(s)
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)
Students with a GPA below a 3.0 may apply for the program but should explain in a separate document how
they will increase their GPA to be competitive for graduate admissions.
How did you hear about the TRIO Ronald E. McNair Scholars Program?
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
Pack Promise Scholar
☐Yes
☐No
At what school(s)?
Do you intend to pursue a graduate degree? Yes No Maybe
Type of degree:
■
204 Park Shops, Campus Box 7105, Raleigh, NC 27695 | Phone (919) 513.7774 | Fax (919) 513.7542
https://trio.dasa.ncsu.edu/mcnair-scholars-program/
5
Masters Doctoral Degree (Ph.D. or Ed.D.) Juris Doctorate (J.D.)
Medical Degree (M.D.) Masters of Business Administration (M.B.A.)
In what field?
Are you currently in the Accelerated Bachelor’s/Master’s Program or plan to apply? Yes No Maybe
Do you have research experience? Yes No
If so, please share the name and lead researcher for the project. If it was a formal program, please share the
name of the program, as well:
EDUCATIONAL INTEREST
Anticipated Field of Doctoral Study: _______________________________________________________________
Graduate Programs you are interested in visiting: ____________________________________________________
Potential Faculty Mentor(s) Information:
____________________________________________________________________________________________
Name Email Dept.
* The TRIO 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.
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.
I: 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?
II: 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 McNair
Scholars Program assist you in making your educational/career goals possible? Please specify your projected timetable for
obtaining the Ph.D.
III: The NC State TRIO Ronald E. McNair Program’s 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?
IV (Required for students with a Cumulative GPA Below 3.0): In a separate document, please explain your plan to
increase your GPA to be competitive for graduate admissions prior to your last year at NC State.
204 Park Shops, Campus Box 7105, Raleigh, NC 27695 | Phone (919) 513.7774 | Fax (919) 513.7542
https://trio.dasa.ncsu.edu/mcnair-scholars-program/
6
RECOMMENDATIONS
To be considered complete, your application MUST have two recommendation letters and forms. Recommenders
should complete either the attached Faculty/Staff Recommendation Form or the online version available at
go.ncsu.edu/mspform
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 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 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 1974. 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 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
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 McNair Scholars Program.
_______________________________________________________________________________________________
Signature Date
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204 Park Shops, Campus Box 7105, Raleigh, NC 27695 | Phone (919) 513.7774 | Fax (919) 513.7542
https://trio.dasa.ncsu.edu/mcnair-scholars-program/
7
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 (Questions provided on page 5)
☐ Résumé
☐ Two Completed Recommendation Forms and Letters are REQUIRED from TWO Faculty members:
Recommendation forms and letters can be mailed to the TRIO McNair Scholars office (Park Shops 204,
Campus Box 7105, Raleigh, NC 27695) or completed online at go.ncsu.edu/mspform
*If you are unable to identify two faculty members, please identify a recommender that can speak to your
academic abilities and potential to succeed as a graduate student. Note: One recommendation MUST be from
a faculty.
☐ Writing Sample. Attach a writing sample of at least 3 pages that was completed in the last year. Please
choose an academic sample, if possible from a course in your major.
☐ Signed Information Release Form
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 ___________
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Ronald E. McNair Post-Baccalaureate Achievement Program (North Carolina State University)

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Completed 19 August 2021

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