01-TRIO McNair Scholars Pre-Application_Copy

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University of Montevallo
Lower Level Main Hall B45
75 College Drive
Station 6570
Montevallo, AL 35115
*************@montevallo.edu
Telephone: (205) 665-6570
Fax: (205) 626-0075

McNair Scholars Program Pre-Application

UMID:

First Name:

Last Name:

ContactPhone:

UM Email:

Secondary Email:

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Address Information:

Local Address Home Address

Address:

City:

Campus State:

State:

Campus Zip:

Zip:

Gender:

Citizenship Status:

Current Major

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Ethnicity (Choose all that apply):

African American

Hispanic

Asian

Native American

Pacific Islander (Native Hawaiian, Guamanian, Samoan)

Caucasian

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