McNair Scholar Survey
Contact Information
* Required Information
*
First Name:
*
Last Name:
*
Address:
*
City:
*
State:
*
Zip Code:
*
Phone:
*
E-mail Address:
Current Status
Check here and fill in the following information
if you are currently enrolled in a university:
(otherwise, please scroll down to the next section)
Name of University:
Date Enrolled:
Degree Currently Pursuing (check all that apply)::
BA/BS
MA/MS
PhD
Other
(please specify below):
Year in the Program:
Expected Completion Date:
Field/Area:
Degrees Awarded
1. Degree Obtained:
Type of Degree:
BA/BS
MA/MS
PhD
Institution That Awarded the Degree:
Date of Completion (mm/dd/yyyy):
2. Degree Obtained:
Type of Degree:
BA/BS
MA/MS
PhD
Institution That Awarded the Degree:
Date of Completion (mm/dd/yyyy):
3. Degree Obtained:
Type of Degree:
BA/BS
MA/MS
PhD
Institution That Awarded the Degree:
Date of Completion:
Brief Bio & Picture
Please provide a brief biography on your successes and accomplishments (i.e. graduate school,
career achievements, marriage, family, etc.):
To help with the creation of an Alumni Yearbook, please provide a picture (JPEG) of yourself
(email your picture as an attached file to
churd@kent.edu
; please include your name in your email)
Check Here If You Will Be E-Mailing a Picture:
If you have problems submitting this survey, please contact
churd@kent.edu