The Ronald E. McNair
Postbaccalaureate Achievement Program
Buffalo State College
2014-2015 Participant Application
About us…
The Ronald Erwin McNair Post-Baccalaureate Achievement Program, named after the late Dr.
Ronald Erwin McNair, Physicist & Astronaut, is a federal TRIO program funded at a hundred
and seventy nine institutions across the United States and Puerto Rico by the U. S. Department of
Education.
The McNair Program is designed to prepare participants for doctoral studies through
involvement in research and other scholarly activities. Institutions work closely with these
participants and track their progress to successful completion of advanced degrees. The
Program's goal is to increase graduate degree attainment of students from underrepresented
segments of society.
Benefits….









Work closely with a Faculty Mentor
One funded summer research internship (totaling $1600)
Writing/research courses/workshops, fall & spring semester ($600 academic year end)
$300 each semester senior year
Graduate school and GRE preparation workshops
Assistance in locating financial aid for graduate school
Academic counseling
Graduate school visits
Opportunities to present at regional and national conferences
Eligibility…





You are either a first-generation college student who also is low-income as established by
the US Department of Education; or a member of a group underrepresented in graduate
education.
You are a United States citizen, permanent resident, or student in the United States for a
non-temporary purpose;
You are interested in research and university level teaching.
You have a 3.0 minimum cumulative GPA and have earned between 25-70(maximum)
credits.
You are a full-time matriculated Buffalo State student.
The enclosed materials were compiled through a grant from the U.S.Department of Education. However, the
contents have not been reviewed by the Department and no endorsement should be inferred.
The Buffalo State College McNair Scholars Program is 100% federally funded Trio Program.
1
Please type or print neatly. Make sure to answer ALL questions
Personal Data
Name____________________________________________________ Date_______________________
Date of Birth_____________________Student ID No._____________________ Gender: ( ) M ( ) F
Ethnic Heritage: ( ) African-American/Black ( ) Asian ( ) Hispanic/Latino ( ) White
( ) American Indian / Alaska Native ( ) Native Hawaiian /Other Pacific Islander
( ) Other _________________________________________
Please indicate your citizenship status: ( ) U.S. Citizen
( ) Permanent Resident
( ) Other _________________________ (please provide photocopy of INS documentation)
Current Address (campus or local residence)
Street_________________________________________________Apt. No.__________________
City__________________________________________________ State_______ Zip__________
Phone (H)_________________________(Cell)________________________________________
BSC Email Address______________________________________________________________
Alternative Email _______________________________________________________________
Permanent Contact
Name________________________________________Relationship________________________
Street________________________________________Phone_____________________________
City_________________________________________State_________________Zip__________
Past TRIO participation?
____TS ____ UB ____ UB/MS ____ UB VET ____EOC
What other programs do you currently participate in?
____CSTEP ____ SSSP ____ EOP ____TOC ____Burrell ____ NONE
____Other (please list) ________________________________
Name of Counselor/s ________________________________
Academic Data
List any other institutions you have attended
Institution________________________________Location__________________From_______ To_______
Please provide a transcript (unofficial is acceptable); if a transcript is unavailable please provide a listing of
transferred credits with grade from Degree Navigator.
How many total cumulative credit hours have you earned? ____________
How many credit hours are you currently registered for? _________
What is your anticipated graduation date? ___________
What is your major? ___________________ What is your cumulative grade point average? ____________
What is your minor? ___________________ Status: Full-time________ Part-time_________
2
Plans for graduate study:
Do plan to pursue a doctoral degree (Ph.D.)?_________ If so in what field?_________________________
Do you plan to pursue an MD, JD, or MBA?_________
INCOME/ FIRST GENERATION STATUS VERIFICATION
Does someone claim you as a dependent for tax purposes? ________
If yes, please list name and relationship to you: _______________________________________You will also need
to provide copies of their most recent federal tax forms (first two pages).
If no, please provide documentation of independence and copies of your most recent federal income tax return (first
two pages)
Or you may submit the Financial Aid Office verification of family income form (included in packet).
Please mark ALL statements that best describe your status as a first-generation college student:
□
□
□
□
Neither parent received a four year college degree (BA, BS).
You are from a single-parent household and lived with a parent prior to the age of 18, and that parent did
not receive a four year college degree.
Prior to the age of 18, you did not live with or receive support from a parent or guardian (orphan or ward of
the court, emancipated minor) who has a four year degree.
None of these statements apply.
Mother’s Name: _________________________________________________
Highest level of schooling completed: ________________________________
Father’s Name: __________________________________________________
Highest level of schooling completed: ________________________________
Academic Autobiography
Type an essay (two pages or less, double-spaced) introducing why you want to attend graduate school. Address
each of the following as you consider your response. This essay MUST ACCOMPANY the application.
 What are your career goals?
 Why do you want to attend graduate school?
 What would you like to research and why?
 How will your participation in the McNair Program impact your educational/career goals?
 What else would you like to share with the committee that would make you a strong candidate?
Note: You may want to have someone (academic advisor, EOP advisor, faculty member, etc…) read your
autobiography and offer suggestions. Make sure to give them the above list of questions to use as a guide.
Other Written Requirements
Please submit a paper fro
3
Recommendation Letters (forms attached)
Two letters of recommendation are required. They must be from full-time Faculty/Instructors in your major or your
intended major. An optional third letter may be submitted from a staff member. They should be sent directly to our
office by the parties providing the reference. Please list their names and contact information below. (Make sure that
the persons you are listing have agreed to provide a recommendation.)
Name
Phone
Email
1. _________________________________________________________________
2. _________________________________________________________________
3. _________________________________________________________________
ONLY U.S. CITIZENS AND PERMANENT RESIDENTS ARE ELIGIBLE TO APPLY.
Certificate of Eligibility
This is to certify that I am a citizen or national of the United States; a permanent resident of the United States; in the
United States for other than a temporary purpose and able to provide evidence from the Immigration and
Nationalization Service of my intent to become a permanent resident; or a permanent resident of the Trust Territory
of the Pacific Island, Guam, or the Northern Marina Island.
Signature____________________________________________________Date_____________________
I certify that the information provided on this application is true to the best of my knowledge, and I understand that
any omission or misrepresentation of facts or failure to furnish information will automatically invalidate
consideration of this application and/or acceptance into the program.
I authorize the Ronald E. McNair Program to secure the financial and academic information necessary to determine
my eligibility and otherwise administer the program.
Signature___________________________________________________ Date____________________
Release of Information
I authorize the Buffalo State McNair Scholars Program to provide information to or to receive information from
other educational institutions regarding reported standardized test scores, acceptance and attendance dates, and
progress being made towards the attainment of my current and future academic pursuits.
Signature___________________________________________________ Date____________________
Application material and questions should be directed to:
Dr. Sandra D. Washington, Director
Buffalo State McNair Scholars Program
SUNY College at Buffalo
Science 253
1300 Elmwood Avenue
Buffalo, NY 14222
Phone-878-3411 Fax- 878-4524
Email -washinsd@buffalostate.edu
Office Use Only







Application
Essay
Writing sample
Resume
Tax Form
2 Letters of Recommendation
Needs Survey
4
FINANCIAL AID OFFICE VERIFICATION OF FAMILY INCOME
I authorize the Student Financial Aid Office at______________________________________________
Name of Institution
to verify my family income by releasing income tax information, need analysis, and various financial aid
information to the Buffalo State McNair Scholars Program.
Print Student’s Name
Date
Student’s Signature
Banner ID #
The information below will be filled out by the Financial Aid Office at Buffalo State College. The McNair
Scholars Program will file this form with the Financial Aid Office upon submission of your application.
AWARD PROGRAM
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
AMOUNT
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
TERM YEAR
___________
___________
___________
___________
___________
___________
___________
___________
TOTAL AWARD
$__________________________________
TOTAL ESTABLISHED STUDENT NEED $__________________________________
STUDENT EFC
$ __________________________________
EXTREMELY IMPORTANT: The official Financial Aid Office information shows the family/student taxable
income and family size for the above named students to be $_______________________ and
Taxable Income
__________________for tax year__________________.
Family Size
Additional Information or Comments:
____________________________________________
Name of Financial Aid Office Official
(
)_____________________________
Office Phone Number
____________________________________________
Signature of Financial Aid Office Official
_________________________________
Date
Return to: McNair Scholars Program
Dr. Sandra D. Washington, Director
Science Building Room 253
1300 Elmwood Ave.
Buffalo, NY 14222
Phone: (716) 878-3411
Fax: (716) 878-4524
5
Buffalo State College
McNair Scholars Program
Needs Survey
Name:
Grant Year:
Graduate School Programming and Planning (Circle Response)
1=strongly disagree
2=disagree
3= neutral
4=agree
5=strongly agree
1.
I am knowledgeable about graduate school requirements for admission.
1
2
3
4
5
2.
I am familiar with research methodology and its applications.
1
2
3
4
5
3.
I am familiar with teaching careers at the college level.
1
2
3
4
5
4.
I have written research reports and made presentations at conferences/symposiums.
1
2
3
4
5
5.
I am familiar with the steps on writing for publication.
1
2
3
4
5
6.
I am knowledgeable of financial aid sources to pay for graduate school.
1
2
3
4
5
7.
I am aware of the steps to obtain a doctoral degree (PhD).
1
2
3
4
5
8.
I am familiar with “networking” and “mentoring” and its impact on your professionalism.
1
2
3
4
5
9.
I am aware of doctoral study tenets and how to manage tasks to reach your goals.
1
2
3
4
5
II.
Related Graduate School Planning
1.
I am familiar with the term “Senior Rule” and its policies.
1
2
3
4
5
2.
I am comfortable with writing personal statements, vitae, and resumes.
1
2
3
4
5
6
3.
I am familiar with how to apply for graduate assistantships.
1
2
3
4
5
4.
I am familiar with strategies in developing critical thinking skills.
1
2
3
4
5
5.
I am aware of the GRE, its contents, and test preparation resources.
1
2
3
4
5
III.
Specific Skill Development
Circle the following skill(s) which you feel least comfortable with?




IV.




Computer Skills
Library Research
Time Management
Test Taking
Research (Hands-on)
Research Paper Development
Statistical Analysis
Presentation Skills
Personal-Social Development
Listed below are a number of areas of your life that may influence your studies and your work as a student.
Identify the item(s) you may need to receive counseling for by circling them.
Key Areas of Need:
Insurance
Employment
Child-care
Budgeting skills
Housing
Transportation
Relationships (interpersonal):
Parents
Spouse
Children
Siblings
Friend(s)
Significant Other
Roommate
Relationships (campus):
Student and/or peer
Faculty Research Mentor
Faculty Mentor Faculty/Staff
Personnel
McNair Scholars Staff
09/14
7