Student Application Form

SECTION I - APPLICANT INFORMATION
Student's Name*

First NameMiddle InitialLast Name
Current Address *

Street Address

Street Address Line 2

CityState / Province

Zip Code
Phone Number*
Kean Email*
Personal Email*
Kean ID #:*
SSN#:*
Gender*
Date of Birth *

DayMonthYear
Black or African AmericanHispanic/LatinoAmerican Indian/Alaskan NativeNative Hawaiian or other Pacific islanderWhiteAsianOther
U.S. CitizenPermanent Resident

Rows	Fill in answers below:
State of Family Residence: (i.e.; NJ, NY, PA, etc.)
Taxable Income: Line 15 on Form 1040
Household Size: Include number of students (even if living away at college), parents, and siblings who are under the age of 24, if the parents provide more than half of their support. Also include other people if they now live with the parents, and the parents provide more than half of their support. If parents are divorced, include only the parent with whom the student lives (custodial parent) and step-parent if applicable.
If your parent(s) did not or will not file taxes for the 2022 tax year, please initial on this line. If they did (or will be going to), please put N/A.

SECTION V - PERSONAL STATEMENT

Please attach your TYPED personal statement (maximum 350 words) to your completed application form. The font should be no larger than 12 points and the style should be Times New Roman. In your statement, be sure to discuss all of the following points:
1. Why would you like to become a participant in the McNair Program?
2. What are your academic goals?
3. How will the McNair Program help you reach your academic goals?
4. Why do you want to pursue a graduate degree?
5. In what kind of graduate programs are you interested? Why?
PERSONAL STATEMENT*

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SECTION VI - Resume/CV
Please attach your resume to your completed application form. Do not exceed two pages. You can include honors and awards, extra-curricular activities, conferences presented, publications (if any), work experience, languages, etc.
Resume/CV*

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SECTION VII - RECOMMENDATIONS

Please provide us with the names of two (2) faculty members who can assess your aptitude for research and motivation to attend graduate school. Recommendation forms should be emailed directly to mcnair@kean.edu.
Reference #1*

NameKean Email
Department*
Reference #2*

NameKean Email
Department*
SECTION VIII - AFFIRMATION
*** PLEASE READ THE FOLLOWING AND SIGN BELOW ***
I affirm that all information in this application is correct. I understand that participation in the Summer Research Institute (SRI) will be a priority and I will not take any additional summer courses or assume any other academic responsibilities. If I am accepted as a McNair Scholar, I will participate in all required activities during the academic year. I agree to provide and regularly update contact information as necessary. By accepting admission to the McNair Program, I agree to comply with all program rules, regulations, and future requests for information regarding my educational status until I earn a Ph.D. The program has permission to utilize my name, photographs, and research for the purposes of recruitment, publicity, and tracking.
Signature*

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Date*

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SECTION I - APPLICANT INFORMATION

SECTION II - ACADEMIC INFORMATION

SECTION III - FAMILY INFORMATION

SECTION IV - FINANCIAL INFORMATION

Please sign below

SECTION V - PERSONAL STATEMENT

SECTION VI - Resume/CV

SECTION VII - RECOMMENDATIONS

SECTION VIII - AFFIRMATION