If you are a sophomore/junior at Southeast Missouri State University who is planning to attend graduate school, the McNair Scholars Program may be of interest to you. Please complete this preliminary application for an initial assessment of your eligibility. Complete this form and return to University Center, Room 414. For questions, call 573-986-6117 or E-mail mcnair@semo.edu.

General Information

Date:
Southeast ID:
Gender:
Male    Female
Last Name:
First Name:
Middle Name:
Local Address:
 City:
 State:  
  
Zip:
Local Phone:
 Cell Phone:
  
Southeast E-Mail: (required)
 Personal E-Mail:
  
Permanent Address:
 City:
 State:  

Zip:
Beginning Date at Southeast:
 Anticipated Graduation Date:
  
Major:
 Anticipated Future Career:
  
Indicate if you have previously participated in any of these TRIO Programs:
Educational Opportunity Center   Student Support Services   Talent Search   Upward Bound  

Eligibility Information

Class Standing:
Freshman (0-30 hrs)    Sophomore (31-60 hrs)    Junior (61-90 hrs)    Senior (90+ hrs)
Cumulative Grade Point Average:
 U.S. Citizen:
Yes     No
Race/Ethnicity:
American Indian    Black    Hispanic    Native Alaskan, Hawaiian, or Pacific Islander
Other (please list):
Has either of your parents earned a four-year bachelor's degree?
Yes     No
Degree(s) you plan to earn:
   Bachelor’s Degree    Master’s Degree    Doctorate
Do you currently receive Pell Grant funding?
Yes     No		 Financial Aid Status:
Independent     Dependent

Using your financial aid status, indicate the number of people in your household and your taxable income*:

Number of People in Household

Taxable Income*

1

$16,245 or less

2

$21,855 or less

3

$27,465 or less

4

$33,075 or less

5

$38,685 or less

6

$44,295 or less

7

$49,905 or less

8

$55,515 or less

 

$55,516 or more

*Taxable income is the adjusted gross income minus exemptions as reported on the most recent federal income tax return on which you were claimed. If your financial aid status is dependent, use your parent(s) or guardian(s) tax return information. If your financial aid status is independent, use your tax return information.

I certify all of the above information to be true to the best of my knowledge and I hereby authorize the McNair Scholars Program to obtain educational records and information, as deemed appropriate by the program staff. The information requested in this form is used strictly to determine program eligibility as well as to provide program demographics to the Department of Education. ALL information will be kept confidential by the program staff. The Southeast Missouri State University McNair Scholars Program does not discriminate on the basis of ethnicity, gender, age, national origin, or handicap.

Re-Type your name to sign this form and then click submit: