Thank you for your interest in our McNair Scholars program!  Please complete this form as thoroughly as possible.  If you have any questions, please email us at

General Information:
First Name *
Middle Name *
Last Name *
Preferred First Name
Preferred Pronouns
Date of Birth *
Address *
Address 2
City *
State *
ZIP Code *
Cell Phone *
School Email Address *
Academic Information
Current Class Level *
Major *
Current GPA
Do you qualify as an independent student for financial aid purposes? *
Tell us how you heard about the McNair Scholars Program *