McNair Program Application Section #1- Student Information Question Title * 1. Student Information Name EMPL ID Date of Birth (D/M/Y)[ex. 01/25/1998] Address City/Town State ZIP/Postal Code John Jay Email Address Phone Number Question Title * 2. Are you a U.S. citizen? Yes No Question Title * 3. Are you a Permanent Resident? Yes No Question Title * 4. Please describe your race/ethnicity. American Indian or Alaska Native Asian or Asian American Black or African American Hispanic or Latino Native Hawaiian or other Pacific Islander White or Caucasian Other (please specify) Question Title * 5. Do you have a physical handicap or learning disability? Yes No If Yes, please specify any accommodations needed. Next
