Welcome to
McNAIR SCHOLARS PROGRAM
Inspiring Innovation. Learn more at www.uwstout.edu/mcnair
TABLE OF CONTENTS
Acceptance Letter
3
Checklist for Paperwork
4
Bio for Website
5
Communication Preference
6
Driver’s Agreement Form
7
Emergency Contact Form
8
Photo and Information Release Form
9
Scholar Commitment Form
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10
CHECKLIST
Biography for Website
Driver’s Agreement Form
Emergency Contact Form
Photo Release Form
Scholar Commitment Form
Copy of Taxes (if limited income)
Needs Assessment Via Qualtrix (watch for link)
Interest Survey Via Qualtrix (watch for link)
Communication Preference
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BIOGRAPHY FOR WEBSITE
Please create a biography for the website and for your folder. Please include background information about
yourself, detail about your research areas/interests/major, and your aspirations toward graduate school and
future career goals. You can see more example biographies here: http://www.uwstout.edu/mcnair/McNairScholar-Biographies.cfm
EXAMPLE: Wade Meyers
My name is Wade Meyers, and I am a first generation college student who grew up in a
small central Wisconsin town called Plainfield. I am in my third year at UW-Stout and
I am majoring in Applied Mathematics and Computer Science. I made the decision to
attend UW-Stout based on my love for math and computers. I liked how UW-Stout had
a major that does an excellent job of combining the two subject areas. I enjoy challenges
and the satisfaction that comes with making progress in or completing challenges. This is
what makes programming and mathematics so rewarding for me.
Through UW-Stout I have been able to gain some undergraduate research experience. I looked at
and compared many different interpolation methods and observed how they handled different sets of scattered
data. I am extremely grateful for the experience I was able to get, and I hope that one day I am able to
continue this type of work in graduate school or beyond. I also have a couple other jobs on campus. I work for
ASK5000, the technology helpdesk at UW-Stout. Within this job I am able to problem solve with coworkers
and clients to address some of UW-Stout’s technology related issues. I am also a tutor on campus. I help
students through ASPIRE-Student Support Services in the subject areas of math and computer science.
When I am not in class, working, or studying, I like to hang out with friends, play video games, watch
movies, or watch football. I enjoy trying new things and love learning new card games or board
games. One recreational thing I have always wanted to do, but have not yet is skydiving.
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COMMUNICATION PREFERENCE
MCNAIR PROGRAM COMMUNICATION PREFERNCE
The McNair Program will contact you through university email (this is a laptop campus, you should be
checking your email frequently throughout the day) and the UW-Stout McNair Scholars Program Facebook
page and LinkedIn. That being said, please list your contact information and your preferred method of
communication:
Preferred Name: Pronouns (circle): He/His/Him
She/Hers/Her
They/Their/Theirs
Address: Home Phone: Cell Phone: May we text you at this number? University Email: Preferred Email (if not University Email): I prefer to be (check one):
Called at Home
Called on My Cell
Texted on My Cell
Emailed
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Driver Authorization & Vehicle Use Agreement
Safety & Risk Management Services - UW-Stout
Complete ALL applicable areas, SIGN, return to Safety & Risk Mgmt. Office, Unversity Services, Room
130. Incomplete forms cannot be approved.
Faculty/Staff/Classified
Student/Volunteer
Birth Date
Name
DRIVER LICENSE INFORMATION
Temporary
Probationary
License #
Regular
State
List any violations and/or accidents, which have occurred in the past three years.
1
2
3
I acknowledge that I have received and/or read a copy of the statewide Fleet Driver and Management Policies
(DOA-3068P; available at: http://www.doa.state.wi.us/docview.asp?docid=3962
I undertand the contents and
agree to comply with the policies.
Signature
Business Phone
Department
Building/Room #
** Insurance information for privately owned vehicles**
Agent's Name
Agent's Number
Changes in insurance information must be reported to Safety & Risk Management Services.
YOU MUST CARRY THE LIMITS REQUIRED BY WISCONSIN STATE LAW._
IF YOU HOLD A LICENSE FROM A STATE OTHER THAN WISCONSIN YOU MUST HAVE THIS
AUTHORIZATION NOTARIZED.
This is to certify that I ________________________________presently hold a valid driver's license from the
state/country of _____and that any/all accidents and violations are listed above.
________________
Date
___________________________________________________
Signature must be signed in presence of Notary
Scribed and sworn to before me this ________________day of ______________________________, 20____.
My commission expires _______________________________________
(SEAL)
___________________________________________________
Notary Signature
____________________________________________________________________
Signature of Risk Management Office indicated approval
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___________________________
Date
EMERGENCY CONTACT INFORMATION
UW-Stout McNair Scholars Program
Please complete this form and return to McNair Student Advisor, 424 Bowman, UW-Stout
Name: ________________________________________________________________
(Please print neatly)
List below the name, address, and telephone numbers of at least two people that we have your permission
to contact in case of an emergency:
Contact #1
Name:______________________________________
Street Address:______________________________________
City, State, Zip Code:
______________________________________
Home Phone: (include area code)
______________________________________
Cell Phone: (include area code)
______________________________________
Relationship to you:______________________________________
Contact #2
Name:______________________________________
Street Address:______________________________________
City, State, Zip Code:
______________________________________
Home Phone: (include area code)
______________________________________
Cell Phone: (include area code)
______________________________________
Relationship to you:______________________________________
Signature: ____________________________________________ Date: ____________
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PHOTO AND INFORMATIONRELEASE FORM
UW-Stout McNair Scholars Program
Photo and Information Release Form
Date:___/___/___
For valuable consideration, I hereby irrevocably consent to and authorize the use and reproduction
by you or anyone authorized by you of any and all photographs which you have this day taken of me,
negative or positive, for any purpose whatsoever including printed publications without further compensation to me. All negatives and positives together with the prints shall constitute your property,
solely and completely.
In addition, I agree to have my professional activities (such as research presentations, participation in
events, and publications) released in printed publications and allow my name as a McNair Scholar to
be released to appropriate entities.
Scholar’s names (print): __________________________________________________________
Scholar’s signature: _____________________________________________________________
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UW-STOUT MCNAIR SCHOLARS PROGRAM
SCHOLAR COMMITMENT
I accept the offer to participate in the Ronald E. McNair Post-baccalaureate Achievement Program. I
understand that the purpose of this program is to encourage me to prepare for doctoral study and research or
college teaching.
I understand that my allowance is earned through my participation in the complete program. Full payment is
dependent upon my attending workshops and scheduled meetings, completing project benchmarks, writing
the research paper, participating in conferences and poster sessions, and submitting an article for the Journal
of Student Research and/or a discipline-specific journal. I will be paid in six installments (between May and
December).
I understand that my paper is due to the McNair Scholars Program office on August 12th, 2016 and failure
to complete the project on time can affect my payment. In addition, all allowance payments are based on
performance and written verification from my research mentor that deadlines and benchmarks are being met. I
understand that the McNair Director reserves the right to delay or withhold allowance payments until she and
my mentor agree the research is being completed to their satisfaction.
I understand health services, housing, meals, personal expenses, and insurance are my responsibility during the
summer portion of the research.
I understand that all McNair events, on and off campus, are alcohol and drug free.
SUMMARY OF SCHOLAR RESPONSIBILITIES
Graduate Record Exam
Appointments
ംം
ംം Attend ALL scheduled program appointments,
meetings, academic year workshops, and
conferences offered by the McNair program
Complete the GRE preparatory workshops
prior to registering for the Graduate Record
Exam, unless an alternative exam is required for
my field of study
ംം Schedule and take the GRE or alternate
entrance exam by August after my junior year
ംം Submit evidence of GRE scores
ംം Attend ALL scheduled appointments with the
McNair staff or call in advance to reschedule
ംം Attend ALL scheduled events and the
GRE Official Test
ംം Meet with research mentor weekly during the
summer research period
Programmatic
ംം Cooperate by completing the annual follow-up
surveys administered by the McNair Program
ംം Send any updated contact information
as it occurs
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SCHOLAR RESPONSIBILITIES CONTINUED
Research
Academic
ംം
Understand that the research opportunity
begins with topic formation late Fall into
January and continues through the summer
where I will devote 20 hours per week to research
ംം Achieve and maintain a GPA of 3.0 or better
ംം
Research is completed under the guidance of a
research mentor and is an ongoing
commitment which includes a paper for
publication and public presentation
of the research
ംം
Understand that my research mentor has the right
and responsibility to make sure my research time
is well-spent during the academic
year/summer session
ംം
Agree NOT to have outside work, courses, or
other commitments that would conflict with my
working steadily and consistently toward
completing my research project
during the summer
ംം Submit my research to a journal for publication
and as a proposal for a conference presentation if
appropriate
ംം Apply for at least three summer research
opportunities off campus if interested in off campus research
ംം Request and receive tutoring in all courses where
I am earning less than a B, or at the suggestion of
the McNair Director and/or Advisor
Graduate Program Applications
ംം Apply to a minimum of five graduate programs with a mixture of Ph.D. and Masters program
submit evidence of these applications to the McNair Staff
ംം Discuss all graduate school offers before accepting
or rejecting any offer with the McNair Director or
Student Advisor
Attitude
ംം Maintain a positive attitude
ംം Have a professional demeanor
ംം Be able to handle constructive criticism
ംം Be involved and ready to learn
ംം Keep in contact at all times with McNair Staff
ംം Communicate in appropriate time when sick or
have other extenuating circumstances
I accept the responsibilites listed above. I also agree to be on campus for 20 hours a week dedicated to the
McNair Scholars Program in the summer during my research project.
Scholar’s signature ______________________________________ Date _______________
Scholar’s name (please print) _________________________________________________
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