Irs Form 1040Ez 2008 by hsd11617

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									                                               WINTER 2010
           RONALD E. MCNAIR SCHOLARS PROGRAM APPLICATION
                                          Please type or print and send to:
                                  RONALD E. MCNAIR SCHOLARS PROGRAM
                                   RECEPTION DESK, 3RD FLOOR MARSHALL
                                       EASTERN MICHIGAN UNIVERSITY
                                               YPSILANTI, MI 48197
                                (734) 487-8240 phone / www.emich.edu/honors/mcnair

Date ________________ Applying for program starting in:           Fall         Winter

 We are temporarily located on the 3rd floor of Marshall. Please drop off application materials at the Reception
           Desk in an envelope or folder, between 8-5 p.m., Monday-Friday by February 1st, 2010.

I. APPLICANT INFORMATION

Social Security Number ________________________                    E ID Number __________________________


Name __________________________________________________________________________________________
           Last                        First                               Middle

Local Address

_______________________________________________________________________________________________
           Street                       City                                State     Zip

Local Telephone Number (        )______________   E-mail Address _______________________________________


Permanent Address __________________________________________________ Telephone (              )______________
                  Street              City             State    Zip

Date of Birth _________________________            Place of Birth ________________________________________
                 Month/Day/Year                                      City                         State

Name of Parent (s) or Guardian (s) __________________________________________________________________


Address __________________________________________________________ Telephone (                )______________
            Street              City              State    Zip

Sex:       Female        Male

Citizen:       United States           Permanent Resident                 Other _________________________
                                   (If applicable, please provide a photocopy of INS documentation)

Ethnic Heritage:         American Indian or Native American              Hispanic or Latino
                         Asian                                           White
                         Black or African American                       Native Hawaiian or Other Pacific Islander
                         Other __________________

How did you hear about the McNair Scholars Program?
                        Letter sent to home                              Classroom Visit
                        Professor/ Mentor                                Website
                        Academic Advising                                Honors College
                        Other __________________

Dec. 11 2009                                                                                                     1
II. FAMILY INFORMATION
Statement of Confidentiality. The information contained in the application is for the purpose of determining the
applicant’s eligibility for the McNair Program. Information received is treated confidentially.

For financial aid purposes, are you considered dependent or independent? If your parents/guardians claim you on their
income tax return, you are considered dependent (Complete Section A). If not, you are considered independent
(Complete Section B).

                                   Section A (Dependent on parent/legal guardian)

What is the size of your parents’ household, as stated on the 2008 IRS form, including yourself? _________

Did your parents file a federal income tax return for the 2008/09 period?                Yes    No

If yes, what was their taxable income:
                                                                IRS Form 1040
          $ _________________                                   IRS Form 1040 A
                                                                IRS Form 1040EZ
If no, place a “0” on the line for taxable income.

Do your parents claim you as a dependent on their income tax return?          Yes        No

                                Section B (Not dependent on parent or legal guardian)

What is the size of your household, including yourself, spouse, and/or other dependents, as stated on the 2008 IRS
form? ____________
Did you file a federal income tax return for the 2008/09 period?       Yes         No
If yes, what was your taxable income:
                                                               IRS Form 1040
         $ _________________                                   IRS Form 1040A
                                                               IRS Form 1040EZ

If no, place a “0” on line for taxable income.

For purposes of documentation, please attach to your application a photocopy of your parent’s or guardian’s
federal income tax form, your income tax form, and if applicable, a copy of your most recent financial aid
transcript.

Attach a copy of your Financial Aid form (FAFSA).

Does your family receive assistance from any of the following sources?

Aid to Families with Dependent Children (AFDC)                Yes                      No
Social Security                                               Yes                      No
Veterans’ Benefits                                            Yes                      No
Food Stamps                                                   Yes                      No
Unemployment Compensation                                     Yes                      No
Other _______________________________                         Yes                      No

Educational Attainment of Mother:
Highest Grade Completed: 1 2 3           4   5   6   7   8   9 10   11   12    13   14      15 16

College Degree Earned, if any:               Bachelor’s                     Master’s                 Doctorate

Educational Attainment of Father:
Highest Grade Completed: 1 2 3           4   5   6   7   8   9 10   11   12    13   14      15 16

College Degree Earned, if any:               Bachelor’s                     Master’s                 Doctorate



Dec. 11 2009                                                                                                            2
III. EDUCATIONAL INFORMATION

Present college or university: _______________________________________________________________

When did you first enroll in a college or university? Month ________________ Year _________________

Will you have only one academic year left in your undergraduate program at the end of Winter term?
                                             □ Yes  □   No
What is your current major or area of concentration? _____________________________________________________



Courses Complete in Major                                                    Grade




     Major GPA: ___________                  Cumulative University GPA:__________
     ACT Score:_________                     SAT Score:__________

Number of credits that will be completed by the time of admission to the Program: ____________

When is your projected graduation date? Month _________________ Year ________________
Do you intend to pursue a doctoral degree?       □Yes        □No          □Undecided
          In what field?________________________________________________


Do you intend to pursue a MD, JD, or MBA?        □Yes        □No          □Undecided
Current EMU students: Please attach copy of unofficial transcript to application.
Non-EMU students: Please have official transcripts of all college courses sent to: McNair Scholars Program, 373
Marshall, Eastern Michigan University, Ypsilanti, MI 48197. Transcripts must arrive by the application
deadline.




Dec. 11 2009                                                                                                  3
IV. ADDITIONAL REQUIREMENTS FOR APPLICANTS
Two (2) letters of recommendation should be submitted with the recommendation form in their original sealed
envelopes and the recommender’s signature across the envelope seal. One (1) of these recommendations must be
completed by faculty members in your major who can best assess your ability for academic research and your
motivation to attend graduate school.

List the names, titles, addresses, email addresses and telephone numbers of your two recommenders:
_______________________________________________________________________________________________

_______________________________________________________________________________________________

Please provide the name, title, address, and telephone number of the person who first encouraged you to apply for the
McNair Program.
____________________________________________________________________________

Personal Statement. On a separate sheet, please submit an essay explaining (a) your academic interests, (b) your career
goals, (c) why you want to attend graduate school, (d) how participation in the McNair Program will assist you in
attaining your goals, and (e) any non-academic challenges that you believe that you face in achieving your goals. In
discussing the academic area you would like to research if selected to participate in the McNair Program, be as specific
as possible about topics of particular interest and any prior research experience you have had (NOTE: prior research
experience is not required).


Check the TRIO Program (s) in which you have participated (if any):
                   Upward Bound
                   Talent Search
                   Student Support Services
                   Upward Bound
                   Education Outreach Center
                   Math/Science Upward Bound


Certification of Accuracy

My signature below indicates that, to the best of my knowledge, all the information given on this application is true,
complete, and accurate.

Applicant Signature __________________________________________ Date ____________________

My signature below indicates that, to the best of my knowledge, all the information given on this application is true,
complete, and accurate.

Parent Signature, if a dependent ___________________________________ Date ____________________


Please return fully completed Application, Official Transcript, Financial Aid and Income Tax Forms, two (2)
Evaluation Sheets and two (2) Letters of Recommendation to the McNair Research Scholars Program to the 3RD Floor
Reception Desk¸ Marshall Building in a folder or envelope. (Late and/or incomplete applications will not be
considered.)



Application Checklist

   McNair Program Application form
   Copy of Financial Aid form (FAFSA)
   Transcripts (unofficial EMU; official if not EMU)
   Personal Statement
   Two (2) letters of recommendation, with recommendation forms


Dec. 11 2009                                                                                                             4
                                     RECOMMENDATION FORM
                                             McNair Scholars Program
                                                    373 Marshall
                                            Eastern Michigan University

Instructions: The student named below is applying for admission to the Eastern Michigan University McNair Scholars
Program. The program is designed to prepare motivated, talented undergraduates for admission to, and completion of,
Ph.D. programs. In order to select those students most likely to succeed in this challenging program, we must rely on
input from you, the student’s referee. Please complete this form and attach a statement of your evaluation of the
student’s demonstrated potential for this program. When completed, please return this form to the students in a sealed
envelope, signed across the flap. Please call the McNair office at (734) 487-8240 for any questions.

(print or type)
Student Name: ________________________________________________________________________________
                Applicant’s Last Name       First Name                    Middle Name

Reference completed by: _________________________________________________________________________
                                   Name
 ____________________________________________________________________________________________
        Title                                  Address                           Telephone

The family Education Rights and Privacy Act of 1974 gives students rights to inspect and review their educational
records. You may, however, waive the right to see specific confidential letters.

   I hereby waive my right to examine this letter and understand that it will not be shared with me.
   I do not waive my right to examine this letter. Failure to sign or indicate waiver status indicates confidentiality by
default.

Signature: _______________________________________________________                      Date _____________________

In what capacity have you known this student? _______________________________________________________

          For how long?__________________________________________________________________________

In which of your classes has this student enrolled, and what grade did he/she receive? _________________________


Please rate this applicant relative to others whom you have known in the same context in recent years:

CRITERIA                                 Exceptional    Above        Average       Below         Poor          Unable to
                                                        Average                    Average                     Judge
Motivation for graduate study
Analytical skills
Communication skills:
-Oral
-Written
Ability to work independently
Ability to work with others
Potential for graduate school
success
Self-motivation
Social sensitivity
Personal responsibility
Please attach written statement addressing specific attributes of this student that you believe predict his/her success.

 ___________________________________________                       __________________________________________
Signature                                                         Date



Dec. 11 2009                                                                                                                5
                                     RECOMMENDATION FORM
                                             McNair Scholars Program
                                                    373 Marshall
                                            Eastern Michigan University

Instructions: The student named below is applying for admission to the Eastern Michigan University McNair Scholars
Program. The program is designed to prepare motivated, talented undergraduates for admission to, and completion of,
Ph.D. programs. In order to select those students most likely to succeed in this challenging program, we must rely on
input from you, the student’s referee. Please complete this form and attach a statement of your evaluation of the
student’s demonstrated potential for this program. When completed, please return this form to the students in a sealed
envelope, signed across the flap. Please call the McNair office at (734) 487-8240 if you have any questions.

(print or type)
Student Name: ________________________________________________________________________________
                Applicant’s Last Name       First Name                    Middle Name

Reference completed by:_________________________________________________________________________
                                  Name
 ____________________________________________________________________________________________
        Title                                 Address                           Telephone

The family Education Rights and Privacy Act of 1974 gives students rights to inspect and review their educational
records. You may, however, waive the right to see specific confidential letters.

   I hereby waive my right to examine this letter and understand that it will not be shared with me.
   I do not waive my right to examine this letter. Failure to sign or indicate waiver status indicates confidentiality by
default.

Signature: _______________________________________________________                      Date _____________________

In what capacity have you known this student? _______________________________________________________

          For how long?__________________________________________________________________________

In which of your classes has this student enrolled, and what grade did he/she receive? _________________________


Please rate this applicant relative to others whom you have known in the same context in recent years:

CRITERIA                                 Exceptional    Above        Average       Below         Poor          Unable to
                                                        Average                    Average                     Judge
Motivation for graduate study
Analytical skills
Communication skills:
-Oral
-Written
Ability to work independently
Ability to work with others
Potential for graduate school
success
Self-motivation
Social sensitivity
Personal responsibility
Please attach written statement addressing specific attributes of this student that you believe predict his/her success.

 ___________________________________________                       __________________________________________
Signature                                                         Date



Dec. 11 2009                                                                                                                6

								
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