ST. LAWRENCE UNIVERSITY

Ronald E. McNair Scholars Program

Name:
Today’s Date:
Name/Maiden:
Name/Married:
SLU Major (s):
Year of Graduation:
Street Address:
Mailing Address:	* if different from street
City:
State:
Zip Code:
Home Phone:
E-Mail Address:
Web Page Address:

*Please complete this section if you are attending graduate/professional school*

College/University

Attending:
Major:
Intended Degree:
Intended Year of Graduation:
Highest Degree earned:	Bachelors \| Masters \| Doctoral
Date Degree Earned:
Attendance:	Full-time \| Part-time
Career Goal:

*Please complete this section if you are employed*

Employment Information

Employer:
Job Title:
Employer’s Street Address:
Employer’s City:
Employer’s State:
Employer’s Zip:
Business Phone:
Business Fax:
Job Responsibilities:

Would you like to receive the McNair newsletter? Yes \| No

Where would you like it mailed? -


What may we say about you in the McNair newsletter? If anything.