Back
Application to Ronald McNair Program East Tennessee State University P.O. Box 70597 Johnson City, Tennessee 37614 Telephone: (423) 439-4879 Fax: (423) 439-4880 Statement of Confidentiality The information contained in this application is for the purpose of determining the applicant's eligibility for the McNair program. All information received is confidential. General Information: What term would you like to be considered for enrollment? Summer (enter year) Date of Application Are you a previous McNair Intern? Yes No If yes, when and where. Personal Data: ETSU Student ID # (if applicable) Last First Middle Birth date Current Address City State Zip Telephone Permanent Address: City State Zip Permanent Telephone Primary E-mail Address Cell Education: College/University: Location: Undergraduate Major: GPA Number of credit hours completed prior to the date you plan to begin the McNair program: Prior TRIO Program Experience: Upward Bound Talent Search/EOC Student Support Services Other Check your career interest: Business Education Technology Bio-Medical Mathematics English Social Studies Life Sciences Journalism History Health Sciences Physical Science Other Which degrees do you intend to pursue? Masters MD JD (law degree) Ph.D Ed.D Pharm.D Dentistry Physical Therapy Other I am not sure Prior Research Experience (excluding course projects) Yes No Recommendations: Give the names, positions, and addresses of two individuals whom you have asked to complete the recommendation forms that you received with this application. Please be sure that these individuals are the same ones completing the evaluation forms. Please note: At least one of these recommendations MUST be from a professor. Mr. Ms. Dr. Name Position Institution's Address City State Zip E-mail (Required) Mr. Ms. Dr. Name Position Institution's Address City State Zip E-mail (Required) I certify that the information on this application is complete. and correct to the best of my knowledge. Date Typed Signature Back
Application to
Ronald McNair Program
East Tennessee State University
P.O. Box 70597
Johnson City, Tennessee 37614
Telephone: (423) 439-4879
Fax: (423) 439-4880
Statement of Confidentiality The information contained in this application is for the purpose of determining the applicant's eligibility for the McNair program. All information received is confidential.
General Information:
What term would you like to be considered for enrollment?
Summer (enter year)
Date of Application
Are you a previous McNair Intern? Yes No If yes, when and where.
Personal Data:
ETSU Student ID # (if applicable)
Last First
Middle
Birth date
Current Address
City State Zip
Telephone
Permanent Address:
Permanent Telephone
Primary E-mail Address Cell
Education:
College/University:
Location:
Undergraduate Major: GPA
Number of credit hours completed prior
to the date you plan to begin the McNair program:
Prior TRIO Program Experience:
Upward Bound
Talent Search/EOC
Student Support Services
Other
Check your career interest:
Which degrees do you intend to pursue?
Prior Research Experience (excluding course projects)
Yes No
Recommendations:
Give the names, positions, and addresses of two individuals whom you have asked to complete the recommendation forms that you received with this application. Please be sure that these individuals are the same ones completing the evaluation forms. Please note: At least one of these recommendations MUST be from a professor.
Mr. Ms. Dr.
Name
Position
Institution's Address City State
Zip
E-mail (Required)
I certify that the information on this application is complete. and correct to the best of my knowledge.
Date
Typed Signature
