Scholar:

Name:
Gender:
Date of birth:	Format: YYYY-MM-DD
Mailing Address:
E-Mail Address:
Telephone #:

Did you transfer to Portland State University?

Yes

No

Length of time at Portland State University:

As defined by the U.S. department of education and program eligibility requirements, are you a:
Check all that apply.

First-generation college student   Low-income student   Underrepresented student in higher education   Other (please specify)

If you selected other, please specify:

Faculty Mentor: 

Name:
E-mail Address:

(Tenative) Research Project Title:

McNair Program Delivery

1. List, in order of importance to you, 3 goals that you intend to accomplish during the Ronald E. McNair Scholars Program:

1.
2.
3.

2. List, in order of urgency to you, 3 areas that you feel you need help with during the Ronald E. McNair Scholars Program:

1.
2.
3.

3. List, in order of importance to you, 5 expectations you have of the Ronald E. McNair Scholars Program:

1.
2.
3.
4.
5.

4. List, in order of importance to you, 5 expectations you have of the Ronald E. McNair Scholars Program staff:

1.
2.
3.
4.
5.

5. List, in order of importance to you, 5 ways the McNair staff can best assist you during the program:

1.
2.
3.
4.
5.

6. How well do you understand the requirements of the McNair Scholars Program?

I do not understand the requirements   I understand the requirements, but have a few questions   I have a strong understanding of the requirements

7. What areas of the program do you need clarification on?

Graduate School Preparation

8. How confident are you about getting into a PhD program?  Mark the answer that best reflects how you feel at this time.

Don't Know   Not Confident   Confident   Very Confident

9. List, in order of importance to you, 3 challenges that you need to address to improve your chances of getting into a PhD program:

1.
2.
3.

10. List, in order of importance to you, 3 skills or abilities that you believe qualify you for PhD programs:

1.
2.
3.

11. How confident are you in your ability to perform certain tasks associated with graduate school? Please select the appropriate level which best describes how confident you are in your CURRENT ability to successfully complete the following activities.

 

	Not Confident At All	Somewhat Confident	Confident	Very Confident
Obtain your baccalaureate degree within three years	Obtain your baccalaureate degree within three years Not Confident At All	Obtain your baccalaureate degree within three years Somewhat Confident	Obtain your baccalaureate degree within three years Confident	Obtain your baccalaureate degree within three years Very Confident
Design a Personal Education Plan to help you attain your academic goals	Design a Personal Education Plan to help you attain your academic goals Not Confident At All	Design a Personal Education Plan to help you attain your academic goals Somewhat Confident	Design a Personal Education Plan to help you attain your academic goals Confident	Design a Personal Education Plan to help you attain your academic goals Very Confident
Choose an appropriate graduate program for your needs and academic interests	Choose an appropriate graduate program for your needs and academic interests Not Confident At All	Choose an appropriate graduate program for your needs and academic interests Somewhat Confident	Choose an appropriate graduate program for your needs and academic interests Confident	Choose an appropriate graduate program for your needs and academic interests Very Confident
Successfully complete a strong graduate admissions application	Successfully complete a strong graduate admissions application Not Confident At All	Successfully complete a strong graduate admissions application Somewhat Confident	Successfully complete a strong graduate admissions application Confident	Successfully complete a strong graduate admissions application Very Confident
Successfully write a completing graduate admissions essay (or personal statement)	Successfully write a completing graduate admissions essay (or personal statement) Not Confident At All	Successfully write a completing graduate admissions essay (or personal statement) Somewhat Confident	Successfully write a completing graduate admissions essay (or personal statement) Confident	Successfully write a completing graduate admissions essay (or personal statement) Very Confident
Create an academic and professional Curriculum Vitae	Create an academic and professional Curriculum Vitae Not Confident At All	Create an academic and professional Curriculum Vitae Somewhat Confident	Create an academic and professional Curriculum Vitae Confident	Create an academic and professional Curriculum Vitae Very Confident
Confidently request letters of recommendation from Faculty	Confidently request letters of recommendation from Faculty Not Confident At All	Confidently request letters of recommendation from Faculty Somewhat Confident	Confidently request letters of recommendation from Faculty Confident	Confidently request letters of recommendation from Faculty Very Confident
Design a website or electronic portfolio	Design a website or electronic portfolio Not Confident At All	Design a website or electronic portfolio Somewhat Confident	Design a website or electronic portfolio Confident	Design a website or electronic portfolio Very Confident
Register for and successfully complete a graduate admissions test (e.g., GRE, LSAT)	Register for and successfully complete a graduate admissions test (e.g., GRE, LSAT) Not Confident At All	Register for and successfully complete a graduate admissions test (e.g., GRE, LSAT) Somewhat Confident	Register for and successfully complete a graduate admissions test (e.g., GRE, LSAT) Confident	Register for and successfully complete a graduate admissions test (e.g., GRE, LSAT) Very Confident
Be accepted into a graduate program	Be accepted into a graduate program Not Confident At All	Be accepted into a graduate program Somewhat Confident	Be accepted into a graduate program Confident	Be accepted into a graduate program Very Confident
Earn a graduate degree	Earn a graduate degree Not Confident At All	Earn a graduate degree Somewhat Confident	Earn a graduate degree Confident	Earn a graduate degree Very Confident
Find and secure graduate school funding (scholarships, fellowships, teaching or graduate assistantship, financial aid)	Find and secure graduate school funding (scholarships, fellowships, teaching or graduate assistantship, financial aid) Not Confident At All	Find and secure graduate school funding (scholarships, fellowships, teaching or graduate assistantship, financial aid) Somewhat Confident	Find and secure graduate school funding (scholarships, fellowships, teaching or graduate assistantship, financial aid) Confident	Find and secure graduate school funding (scholarships, fellowships, teaching or graduate assistantship, financial aid) Very Confident
Develop a research proposal	Develop a research proposal Not Confident At All	Develop a research proposal Somewhat Confident	Develop a research proposal Confident	Develop a research proposal Very Confident
Brainstorm research ideas	Brainstorm research ideas Not Confident At All	Brainstorm research ideas Somewhat Confident	Brainstorm research ideas Confident	Brainstorm research ideas Very Confident
Conduct a search for relative literature on a research idea	Conduct a search for relative literature on a research idea Not Confident At All	Conduct a search for relative literature on a research idea Somewhat Confident	Conduct a search for relative literature on a research idea Confident	Conduct a search for relative literature on a research idea Very Confident
Evaluate journal articles to determine usefulness in a literature review	Evaluate journal articles to determine usefulness in a literature review Not Confident At All	Evaluate journal articles to determine usefulness in a literature review Somewhat Confident	Evaluate journal articles to determine usefulness in a literature review Confident	Evaluate journal articles to determine usefulness in a literature review Very Confident
Identify the appropriate research methodology for a research project	Identify the appropriate research methodology for a research project Not Confident At All	Identify the appropriate research methodology for a research project Somewhat Confident	Identify the appropriate research methodology for a research project Confident	Identify the appropriate research methodology for a research project Very Confident
Complete an original research project	Complete an original research project Not Confident At All	Complete an original research project Somewhat Confident	Complete an original research project Confident	Complete an original research project Very Confident
Collaborate with a faculty mentor or research group	Collaborate with a faculty mentor or research group Not Confident At All	Collaborate with a faculty mentor or research group Somewhat Confident	Collaborate with a faculty mentor or research group Confident	Collaborate with a faculty mentor or research group Very Confident
Effectively edit your writing	Effectively edit your writing Not Confident At All	Effectively edit your writing Somewhat Confident	Effectively edit your writing Confident	Effectively edit your writing Very Confident
Manage your time effectively within graduate school	Manage your time effectively within graduate school Not Confident At All	Manage your time effectively within graduate school Somewhat Confident	Manage your time effectively within graduate school Confident	Manage your time effectively within graduate school Very Confident
Present your research in public	Present your research in public Not Confident At All	Present your research in public Somewhat Confident	Present your research in public Confident	Present your research in public Very Confident
Submit your paper for publication	Submit your paper for publication Not Confident At All	Submit your paper for publication Somewhat Confident	Submit your paper for publication Confident	Submit your paper for publication Very Confident
Submit proposals for academic research conferences	Submit proposals for academic research conferences Not Confident At All	Submit proposals for academic research conferences Somewhat Confident	Submit proposals for academic research conferences Confident	Submit proposals for academic research conferences Very Confident

Faculty Mentoring

12. List, in order of importance to you, 3 expectations you have for your faculty mentor:

1.
2.
3.

13. List 3 ideal qualities of an effective faculty mentor:

1.
2.
3.

14. List, in order of importance to you, 3 reasons for choosing the faculty mentor you are working with during the McNair Scholars Program:

1.
2.
3.

15. Please rate how beneficial it would be for your mentor to provide knowledge in the following areas:

 

	Not Beneficial At All	Somewhat Beneficial	Beneficial	Very Beneficial
Graduate program information and suggestions on program	Graduate program information and suggestions on program Not Beneficial At All	Graduate program information and suggestions on program Somewhat Beneficial	Graduate program information and suggestions on program Beneficial	Graduate program information and suggestions on program Very Beneficial
Selection of graduate programs	Selection of graduate programs Not Beneficial At All	Selection of graduate programs Somewhat Beneficial	Selection of graduate programs Beneficial	Selection of graduate programs Very Beneficial
Admissions to graduate programs, preparing a graduate admissions application	Admissions to graduate programs, preparing a graduate admissions application Not Beneficial At All	Admissions to graduate programs, preparing a graduate admissions application Somewhat Beneficial	Admissions to graduate programs, preparing a graduate admissions application Beneficial	Admissions to graduate programs, preparing a graduate admissions application Very Beneficial
GRE preparation or test-taking skills	GRE preparation or test-taking skills Not Beneficial At All	GRE preparation or test-taking skills Somewhat Beneficial	GRE preparation or test-taking skills Beneficial	GRE preparation or test-taking skills Very Beneficial
Preparation for graduate education	Preparation for graduate education Not Beneficial At All	Preparation for graduate education Somewhat Beneficial	Preparation for graduate education Beneficial	Preparation for graduate education Very Beneficial
Financial assistance for graduate studies	Financial assistance for graduate studies Not Beneficial At All	Financial assistance for graduate studies Somewhat Beneficial	Financial assistance for graduate studies Beneficial	Financial assistance for graduate studies Very Beneficial
Research skills and how to go about conducting original research	Research skills and how to go about conducting original research Not Beneficial At All	Research skills and how to go about conducting original research Somewhat Beneficial	Research skills and how to go about conducting original research Beneficial	Research skills and how to go about conducting original research Very Beneficial
The culture of the academy and the professoriate	The culture of the academy and the professoriate Not Beneficial At All	The culture of the academy and the professoriate Somewhat Beneficial	The culture of the academy and the professoriate Beneficial	The culture of the academy and the professoriate Very Beneficial
Presenting research findings	Presenting research findings Not Beneficial At All	Presenting research findings Somewhat Beneficial	Presenting research findings Beneficial	Presenting research findings Very Beneficial
Improving academic writing	Improving academic writing Not Beneficial At All	Improving academic writing Somewhat Beneficial	Improving academic writing Beneficial	Improving academic writing Very Beneficial
Stress management	Stress management Not Beneficial At All	Stress management Somewhat Beneficial	Stress management Beneficial	Stress management Very Beneficial
Time management and goal setting	Time management and goal setting Not Beneficial At All	Time management and goal setting Somewhat Beneficial	Time management and goal setting Beneficial	Time management and goal setting Very Beneficial

16. Please check types of activities you would like to engage in with your faculty mentor:

	Check all that apply
Research project	Research project Check all that apply
Graduate school research	Graduate school research Check all that apply
Professional networking	Professional networking Check all that apply
Discussion of writing/publication	Discussion of writing/publication Check all that apply
Job shadowing--Observing your mentor at work	Job shadowing--Observing your mentor at work Check all that apply
Research experience (e.g., compiling data, conducting parts of research)	Research experience (e.g., compiling data, conducting parts of research) Check all that apply
Assisting your mentor in the lab or classroom	Assisting your mentor in the lab or classroom Check all that apply
Other; please specify below	Other; please specify below Check all that apply

Additional comments:

17. In general, how often do you think you should meet in person with your mentor?

2-3 times (plus) per week   Once per week   Every two weeks   Monthly   Other (please specify)

If you selected other, please specify:

Free-Write Section

18. Please free-write for 5 minutes about how you feel right now as you begin the Ronald E. McNair Scholars Program.

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