OMB Approval No: 1840-0640

Expiration Date: xx/xx/20xx

<< DRAFT >> Ronald E. McNair Postbaccalaureate Achievement (McNair) Program

Annual Performance Report – Program Year 2012–13

 

Section I, Part 1—Project Identification/Characteristics

Certification and Warning Statements

A. Project Identification

1. PR/Award Number: [pre-populated] P217A _______________

2. Institutional Sector [pre-populated]_______________________

3. Project Type: [pre-populated] ___________________________ 

4. Reporting Period: [pre-populated] _______________________

5. Name of Grantee Institution: [pre-populated]

_________________________________________________

6. IPEDS UnitID for Grantee Institution: [pre-populated] _______

B. Project Director and Data Entry Person Information

7. Project Director Information [pre-populated]

7a. Name of Project Director: 

______________________ ___ __________________

First Name MI Last Name

7b. Telephone #: (______) ___________________________ 

Area Code Number Ext.

7c. Fax #: (______) _______________________________ 

 Area Code Number

7d. Email Address:_________________________________

8. Data Entry Person Information

8a. Name of Data Entry Person:

____________________ ____ _________________

First Name MI Last Name 

8b. Telephone #: (______) _______________________ 

Area Code Number Ext.

 

8c. Email Address:_________________________________

C. Project Characteristics

9a. Has your project received institutional or other nonfederal funds?

 Yes  No

9b. If “Yes”, please enter the dollar amount for the reporting 

period: $_____________.00.

9c. What type of GPA scale does your institution use?

 4 point scale  5 point scale  Other

9d. Has your project implemented a plan for increasing the 

number of STEM participants?

 Yes  No

9e. Has your project developed an evidence-based system for 

evaluating its own performance?

 Yes  No

D. Certification: We certify that the performance report information reported and submitted electronically on ____/____/______ is readily 

verifiable. The information reported is accurate and complete to the best of our knowledge.

________________________________________________ ______________________________________________

Name of Project Director (Print) Name of Certifying Official (Print)

________________________________ ____/____/______ ________________________________ ____/____/____ Signature 

Date Signature Date

E. Warnings: Any person who knowingly makes a false statement or misrepresentation on this report is subject to penalties which may include 

fines, imprisonment, or both, under the United States Criminal Code and 20 U.S.C. 1097. Further Federal funds or other benefits may be 

withheld under this program unless this report is completed and filed as required by existing law (20 U.S.C.) 1231a) and regulations (34 CFR 

75.590 and 75.720). 

Authority: Public Law 104-13, as amended. 

Paperwork Burden Statement: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid 

OMB control number. The valid OMB control number for this information collection is 1840-0640. The time required to complete this information collection is estimated to average 11 hours per 

response, including the time to review instructions, search existing data resources, gather required data, and complete and review the information collection. The obligation to respond to this 

collection is required to obtain or retain benefit under Title IV, Section 402E, of the Higher Education Act of 1965, as amended (Public Law 102-325). If you have any 

comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4536. If you have 

comments or concerns regarding the status of your individual submission of this form, write directly to: Federal TRIO Programs, U.S. Department of Education, 1990 K Street, N.W., Suite 

7000, Washington, D.C. 20006-8510. 
Section I, Part 2—Project Services

Definitions:

The “Number of participants receiving service that was provided by project” is defined as those participants that were offered services 

by the project and subsequently received services from the project. This figure does not include participants that were offered services 

by the project but declined them (e.g., due to lack of need, participant refused the service, etc.).

The “Number of participants referred to another service provider” is defined as those participants that were offered services by the 

project but were subsequently referred to another service provider. Note that the Department is not asking projects to report on whether 

participants actually received services from the service provider or for projects to follow-up with these participants to ensure services 

were rendered. The Department is only requesting that the projects report on the number of participants that were referred to another 

service provider.

The Department is asking projects to report on the number of participants, not the number of contacts. For instance, if a participant 

received a service that was provided by a project multiple times, he/she should only be counted once for the purposes of this report. 

However, it is possible for a participant to be counted once in each of the two columns for a given service; that is, a participant received 

a service that was provided by the project and was also referred to another service provider.

Seminars/workshops means group activities that provide participants with the opportunity to receive information or practice 

methodology in one or more areas necessary for the successful navigation of the educational system relative to the 

attainment/completion of their doctoral studies. 

Tutoring means individual or small group tutoring provided by a graduate student or a professional staff person. 

Academic counseling means assisting students in making educational plans, selecting appropriate courses, meeting academic 

requirements, and planning for graduation and graduate education. 

Financial aid assistance to graduate school means assisting students individually or in small groups in completing financial aid 

applications and securing fellowships and other forms of financial assistance for graduate study. 

Admission assistance to graduate school means assisting students in choosing graduate or professional programs and applying for 

admission to those programs.

Mentoring means professionals, other than project staff, working with project students to expose them to careers that require doctoral 

degrees. 

Exposure to cultural events and academic programs means any project sponsored activities, such as field trips, special lectures, and 

symposiums that have as their purpose the improvement of the project participants’ academic progress and personal development.

Required Services

Number of participants

receiving service that was

provided by project

Number of participants

referred to another

service provider

 Seminars/Workshops ______ ______

 Tutoring ______ ______

 Academic Counseling ______ ______

 Financial aid assistance to graduate school ______ ______

 Admission assistance to graduate school ______ ______

Permissible Services

 Education/counseling to improve financial and economic literacy ______ ______

 Mentoring ______ ______

 Exposure to cultural events/academic programs ______ ______
OMB Approval No: 1840-0640

Expiration Date: xx/xx/20xx

<< DRAFT >> RONALD E. MCNAIR POSTBACCALAUREATE ACHIEVEMENT (MCNAIR) PROGRAM

2012–13 ANNUAL PERFORMANCE REPORT (APR)

SECTION II – RECORD STRUCTURE FOR PARTICIPANT LIST

A grantee must submit student records in Excel or CSV format. For additional information regarding data submission, please see the instructions under “HOW MAY THE REPORT 

BE SUBMITTED?” Beginning with the 2012-13 APR, the Department requires projects to submit participant records for all students served by the project who attained a 

bachelor’s degree for academic years (cohort years) starting in 2002-03 and must retain this records on the APR data file for a period of ten (10) years.

Field 

#

Field Name

Database Column 

Name Valid Field Content

II.A. Project Identifiers (pre-populated)

1 PR/Award 

Number

PR The eleven-digit PR/Award Number can be found in Block 5 of the project’s Grant Award Notification for the reporting year.

2 Batch Year BatchAY 2012 for Project Year 2012–13

II.B. Participant’s Personal Information 

(Fields #3 through #7 cannot be update.)

3 Social Security 

Number

SSN 001010001 to 999999998

Unknown = 000000000

NOTE: Please format the SSN in nine digits greater than 001010001 unless the SSN is unknown. If using Excel, you may use 

dashes (e.g., 123-45-5667 or 123456789). Do not use letters. The information in this field should not be changed in subsequent 

data submissions.

4 Student’s Last 

Name

LastNM 0 to 9

Uppercase A to Z

. (period)

’ (apostrophe)

- (dash)

First position will be justified with an uppercase A-Z. No blanks will be accepted.

NOTE: The information in this field should not be changed in subsequent data submissions.

5 Student’s First 

Name

FirstNM 0 to 9

Uppercase A to Z

. (period)

’ (apostrophe)

- (dash)

First position will be justified with an uppercase A-Z. No blanks will be accepted.

NOTE: The information in this field should not be changed in subsequent data submissions.

6 Student’s MI Uppercase A to Z
Field 

#

Field Name

Database Column 

Name Valid Field Content

Middle Initial Blank = No response

7 Student’s Date 

of Birth

DOB Participant’s date of birth is:

Format is MM/DD/CCYY

MM = 01–12

DD = 01–31

CC = 19–20

YY = 00–99

00/00/0000 = Unknown

NOTE: The information in this field should not be changed in subsequent data submissions.

II.C. Participant’s Demographic Information and Eligibility Status

8 Gender GenderCD Participant’s gender is:

1 = Male

2 = Female

0 = Unknown

9 Ethnicity—

Hispanic

Hispanic Participant is identified as Hispanic/Latino?

1 = Yes

2 = No

0 = Unknown

Hispanic/Latino refers to a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, 

regardless of race. As such, every Hispanic/Latino person has an associated race(s).

Please provide race information for every participant, ethnicity notwithstanding.

10 Race—

American 

Indian/Alaskan 

Native

AmIndAK Participant is identified as American Indian/Alaskan Native?

1 = Yes

2 = No

0 = Unknown

American Indian/Alaskan Native refers to a person having origins in any of the original peoples of North and South America 

(including Central America), and who maintains tribal affiliation or community attachment. 

11 Race—Asian Asian Participant is identified as Asian?

1 = Yes

2 = No

0 = Unknown

Asian refers to a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, 

including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. 

12 Race—Black 

or African 

American

BlackAfrAm Participant is identified as Black or African American?

1 = Yes

2 = No

0 = Unknown
Field 

#

Field Name

Database Column 

Name Valid Field Content

Black or African American refers to a person having origins in any of the black racial groups of Africa. Terms such as "Haitian" or 

"Negro" can be used in addition to "Black or African American."

 

13 Race—White White Participant is identified as White?

1 = Yes

2 = No

0 = Unknown

White refers to a person having origins in any of the original peoples of Europe, the Middle East, or North Africa. 

14 Race—Native 

Hawaiian or 

Other Pacific 

Islander

HIPacIslndr Participant is identified as Native Hawaiian or Other Pacific Islander?

1 = Yes

2 = No

0 = Unknown

Native Hawaiian or Other Pacific Islander refers to a person having origins in any of the original peoples of Hawaii, Guam, Samoa, 

or other Pacific Islands.

15 Number of 

Hours Worked 

Per Week

HoursWorked On average, how many hours each week did the participant work at a job or internship in this reporting period?

1 = 0

2 = 1 – 15

3 = 16 – 30

4 = 30 – 40

5 = 40 or more

0 = Unknown

Please select the average number of hours worked each week during the 2012-13 academic year. This includes regular jobs, workstudy, assistantships, and traineeships. Please provide this information for both undergraduate and graduate students who were 

enrolled in the reporting period.

16 Low-income EligLowInc Participant is low-income?

1 = Yes

2 = No

0 = Unknown

17 FirstgenerationEligFirstGen Participant is a first-generation college student?

1 = Yes

2 = No

0 = Unknown

18 Underrepresented 

racial/ethnic 

group

EligUnderrep Participant is from a group underrepresented in graduate education?

1 = Yes

2 = No

0 = Unknown

NOTE: The following ethnic and racial groups are currently underrepresented in graduate education: Black (non-Hispanic), 

Hispanic, American Indian/Alaskan Native, and Native Hawaiian or other Pacific Islander.
Field 

#

Field Name

Database Column 

Name Valid Field Content

II.D. Participant’s Project Enrollment Information

19 First School 

Enrollment 

Date 

(Postsecondary 

Education)

FirstEnrollDT Participant’s date of first enrollment into postsecondary education is:

Format is MM/DD/CCYY

MM = 01–12

DD = 01–31

CC = 19–20

YY = 00–99

00/00/0000 = Unknown

20 Project Entry 

Date

ProjEntryDT Participant’s date of first project service is:

Format is MM/DD/CCYY

MM = 01–12

DD = 01–31

CC = 19–20

YY = 00–99

00/00/0000 = Unknown

21 Grade Level at 

Project Entry

EnterGradeLV Participant’s college grade level at entry into the project is:

1 = 1st yr., never attended

2 = 1st yr., attended before

3 = 2nd yr./sophomore

4 = 3rd yr./junior

5 = 4th yr./senior

6 = 5th yr./other undergraduate

7 = Graduate student (any year level)

0 = Unknown

NOTE: Use options 3, 4, 5, and 6 only for students who had the required number of credits and GPA to be classified at the 

institution at the time of project entry as sophomore, junior, senior, and other undergraduate, respectively.

22 Participant 

Status

(during 

academic year 

being 

reported)

PartCD Participant is a:

1 = New Participant

2 = Continuing Participant

3 = Prior-Year Participant

4 = Prior-Year Participant, Deceased

Notes:

 A new participant is an individual who was served by the project for the first time in this reporting period (PY 2012–13).

 A continuing participant is an individual who was served by the project for the first time in any prior reporting period and also 

received services in the 2012–13 reporting period. 

 A prior-year participant is an individual served by the project in any prior reporting period but has not received services 

during the academic year being reported (PY 2012–13).

 A prior-year participant who is deceased is an individual served by the project in any prior reporting period but is now 

deceased.
Field 

#

Field Name

Database Column 

Name Valid Field Content

23 Enrollment 

Status

(during 

academic year 

being 

reported)

EnrollCD Participant’s enrollment status is:

1 = Full academic year (both semesters or three quarters)

2 = Part of academic year (one semester or one or two quarters)

3 = Summer only

4 = Full academic year and summer

5 = Part of academic year and summer

99 = Not enrolled

0 = Unknown

Please provide this information for both undergraduate and graduate students.

24 Project 

Participation 

(during 

academic year 

being 

reported)

ProjPart Participated during:

1 = Full academic year (both semesters or three quarters)

2 = Part of academic year (one semester or one or two quarters)

3 = Summer only

4 = Full academic year and summer

5 = Part of academic year and summer

99 = Not applicable – prior-year participant

0 = Unknown

NOTE: Complete this field for new and continuing students. Select “9” for prior-year participants. 

25 Funding 

Source

FundSource Types of funds used to support this participant during the reporting year are:

1 = Federal funds

2 = Non-federal funds

3 = Partially supported with non-federal funds

99 = Not applicable – prior-year participant

0 = Unknown

NOTE: Complete this field for new and continuing students. Select “9” for prior-year participants.

II.E. Participant’s Academic and Degree Status

26 Main field of 

undergraduate 

study

UnderGradField Participant’s undergraduate main field of study is:



0 = Unknown

Please use the “Main Field of Study” list located in the instructions and provide the 3-digit code for the participant’s 

undergraduate main field of study. Please provide the participant’s main field of study for participants who are ENROLLED in 

undergraduate studies. If the participant attained a bachelor’s degree in this reporting period, please provide the main field of study. 

For all other participants (including graduate students), please enter “001”. Also enter “001” if you do not know the participant’s 

undergraduate main field of study.

 
Field 

#

Field Name

Database Column 

Name Valid Field Content

27 Cumulative 

GPA (upon 

graduation 

with a 

bachelor’s 

degree)

CumGPA Participant’s cumulative GPA upon graduation with a bachelor’s degree is:

0.001 to 5.000

9.999 = Not applicable, participant has not received bachelor’s degree

0.000 = Unknown

NOTE: Provide cumulative GPA for all McNair participants who have graduated with a bachelor’s degree. Do not provide any 

other GPA in this field.

28 Attendance at 

Community 

College

UGTransfer Participant transfer from a community college (2-year institution)?

1 = Yes

2 = No

0 = Unknown

Please do not respond “Yes” if the participant earned college credit through a dual enrollment program.

29 Bachelor’s or 

Equivalent 

Degree

BADegree Participant earned a bachelor’s degree?

1 = Yes

2 = No

0 = Unknown

30 Date of 

Bachelor’s or 

Equivalent

Degree

DateBADegree Date participant earned bachelor’s degree is:

Format is MM/DD/CCYY

MM = 01–12

DD = 01–31

CC = 19–20

YY = 00–99

99/99/9999 = No bachelor’s earned yet

00/00/0000 = Unknown

31 Academic 

(Cohort) Year 

of Bachelor’s 

Degree 

AYBADegCohort Academic year the participant earned their bachelor’s degree is:

1 = Prior to 2002-03

2 = 2002-03

3 = 2003-04

4 = 2004-05

5 = 2005-06

6 = 2006-07

7 = 2007-08

8 = 2008-09

9 = 2009-10

10 = 2010-11

11 = 2011-12

12 = 2012-13

99 = No first bachelor’s degree earned yet

Note: The academic year of the bachelor’s degree (i.e., bachelor’s degree cohort year) should align with field #30, Date of 
Field 

#

Field Name

Database Column 

Name Valid Field Content

Bachelor’s Degree. For example, if the participant earned a bachelor’s degree on May 15, 2006, then the participant’s bachelor’s 

degree cohort year is option #5, 2005-06.

II.F. Participant’s Research and Internships during the Academic Year

32 Research

(2012–13 

academic 

year)

Research To what extent did the student participate in a research activity?

1 = Participated in research but did not complete all of the components of the research activity

2 = Did not participate in Research

3 = Completed all of the components of the Research activity

99 = Not applicable, prior-year participant 

0 = Unknown

33 Internships

(2012–13 

academic 

year)

Internship To what extent did the student participate in a research activity?

1 = Participated in research but did not complete all of the components of the research activity

2 = Did not participate in Research

3 = Completed all of the components of the Research activity

99 = Not applicable, prior-year participant

0 = Unknown

II.G. Participant’s Graduate School Information

34 Graduate 

School 

Admissions 

Test

GradAdmTest Participant completed a graduate school admissions test?

1 = Yes

2 = No

0 = Unknown

35 Number of 

Graduate 

School 

Applications

GradSchApp Participant’s number of graduate school applications submitted during the reporting period is:

1 = 0

2 = 1

3 = 2 – 4

4 = 5 or more

0 = Unknown

36 Graduate 

School 

Enrollment 

Status 

(at the 

beginning of 

the 2013–14

academic 

year)

GradEnrollStatus Participant’s graduate enrollment status in the Fall of the 2013-14 academic year (i.e., for participants who received a 

bachelor’s degree in this reporting period) is:

1 = Enrolled in a post-baccalaureate degree program (for participants who received a bachelor’s degree or equivalent in this 

reporting period)

2 = Did not enroll in a post-baccalaureate degree program (for participants who received a bachelor’s degree or equivalent in this 

reporting period)

3 = Other (for students who did not receive a bachelor’s degree or equivalent in this reporting period)

0 = Unknown

Select option #1 if the student received a bachelor’s degree in this reporting period and enrolled in a post baccalaureate degree 

program in the Fall term of the next academic year.

Select option #2 if the student received a bachelor’s degree in this reporting period and did not enroll in a post baccalaureate 

degree program in the Fall term of the next academic year.
Field 

#

Field Name

Database Column 

Name Valid Field Content

Select option #3 if the student did not receive a bachelor’s degree in this reporting period or received a bachelor’s degree in a 

previous reporting period. 

37 Date of First 

Graduate 

School 

Enrollment

FirstGradEnrollDT Graduate student’s first enrollment date in graduate school is:

Format is MM/DD/CCYY

MM = 01–12

DD = 01–31

CC = 19–20

YY = 00–99

99/99/9999 = Has not yet enrolled in graduate school

00/00/0000 = Unknown

NOTE: Please enter a valid date of entry only once and do not edit this date in future submissions. If you do not know the 

complete date, use 15 for the day and use your best estimate for the month.

38 Institution 

Attended for 

First Year 

Graduate 

Students 

1

stYrGradIPEDS NCES IPEDS ID of the graduate institution attended for graduate students is:

888888 = Not applicable, has not completed undergraduate studies 

999999 = Not applicable, completed undergraduate studies but never enrolled in graduate school

000000 = Unknown 

Provide the six-digit postsecondary institution NCES IPEDS ID for 1st year graduate students only. Once a valid NCES IPEDS ID 

is provided, please do not update this information in subsequent reporting periods. You can obtain the NCES IPEDS ID from the 

following web site: http://nces.ed.gov/globallocator/

39 Graduate 

Student’s Main 

Field of Study

GradStudField Participant’s graduate main field of study is:



0 = Unknown

Please use the “Main Field of Study” list located in the instructions and provide the 3-digit code for the participant’s graduate 

main field of study. If the participant is not in graduate school (e.g., participant is still in undergraduate program or did not enroll in 

graduate school), please enter “001”.

NOTE: Report a field of graduate study only for enrolled graduate students. All other participants should be reported as either 

“001” or “0” for unknown.

40 Graduate 

Assistantships

GradAsstshp Graduate student receive an assistantship during the reporting period?

1 = Teaching Assistantship

2 = Research Assistantship

3 = Other

4 = No Assistantship

99 = Not applicable, student is not enrolled in graduate school 

0 = Unknown

If the participant is not enrolled in graduate school (e.g., undergraduates), please select “99”.
Field 

#

Field Name

Database Column 

Name Valid Field Content

41 First-Year 

Graduate 

Student 

Persistence 

Status 

(at the 

beginning of 

the 2013–14

academic 

year)

FYGradPersistStatus For a participant who is 1st year graduate student in this reporting period, what is the graduate enrollment status at the 

beginning of the 2013-14 academic year?

1 = Still enrolled in a post-baccalaureate degree program (for participants who were 1st year graduate students in this reporting 

period)

2 = No longer enrolled in a post-baccalaureate degree program (for participants who were 1st year graduate students in this 

reporting period)

3 = Other (for students who were not first-year graduate students in this reporting period)

0 = Unknown

Select option #1 if the student was a first-year graduate student in this reporting period and was still enrolled in a postbaccalaureate degree program at the beginning of the 2013-14 academic year.

Select option #2 if the student was a first-year graduate student in this reporting period and was NOT enrolled in a postbaccalaureate degree program at the beginning of the 2013-14 academic year.

Select option #3 if the student was NOT a first-year graduate student in this reporting period.

42 Reason Left 

Graduate 

School

ReaLftGradSch Reason participant left graduate school is:

1 = Academic Problems

2 = Change in family status

3 = Change in program

4 = Done taking classes

5 = Scheduling or availability

6 = Job or military conflict

7 = Needed to work or other financial reasons

8 = Taking time off

9 = Personal problems other than financial

10 = Pursue other interests

11 = Other

88 = Not applicable, still enrolled in graduate school

99 = Not applicable, undergraduate student or never enrolled in graduate school

0 = Unknown

43 Highest 

Graduate 

Degree Earned 

(as of the end 

of the 

academic 

year)

GradDegreeCD Participant’s highest graduate degree earned to date, as of the end of the academic year is:

1 = Master’s Degree

2 = Doctor of Philosophy (Ph.D.)

3 = Doctor of Education (Ed.D)

4 = Doctor of Engineering (D.Eng./D.E.SC/D.E.S)

5 = Doctor of Business Administration (D.B.A.)

6 = Doctor of Science (D.Sc./Sc.D)

7 = Doctor of Health/Nursing Sciences (D.H.Sc/D.N.Sc)

8 = Doctor of Psychology/Social Work (Psy.D/DSW)

9 = First-professional Degree (Law, Medicine, Dentistry, Optometry, Veterinary medicine, Osteopathic medicine, Theology, etc.)
Field 

#

Field Name

Database Column 

Name Valid Field Content

99 = Not applicable, no graduate degree earned

0 = Unknown

NOTE: Use the degree code that indicates the highest graduate degree obtained (regardless of year earned). Repeat each degree 

reporting code every year until a new or more advanced degree has been earned. If no graduate degree has been earned including 

those who have earned a bachelor’s degree only, please select option #99.

44 Date Highest 

Graduate 

Degree Earned

HiGradDegDate Date participant earn highest graduate degree is:

Format is MM/DD/CCYY

MM = 01–12

DD = 01–31

CC = 19–20

YY = 00–99

99/99/9999 = No graduate degree earned

00/00/0000 = Unknown

NOTE: Repeat the same date until a new and more advanced degree is earned. If you do not know the complete date, use 15 for 

the day and use your best estimate for the month. If no graduate degree has been earned including those who have earned a 

bachelor’s degree only, please enter 99/99/9999. Once the doctorate degree has been provided, please do not change the 

response in subsequent reporting periods.

45 Institution 

Where 

Doctorate was

Earned 

GradStudDocIPEDS NCES IPEDS ID where the participant earned their doctorate is:

888888 = Not applicable, has not completed undergraduate/graduate studies 

999999 = Not applicable, completed undergraduate/graduate studies but did not earn a doctorate degree.

000000 = Unknown 

Provide the six-digit postsecondary institution NCES IPEDS ID for participants who attained a doctorate degree Once a valid 

NCES IPEDS ID is provided, please do not update this information in subsequent reporting periods. You can obtain the NCES 

IPEDS ID from the following web site: http://nces.ed.gov/globallocator/

46 Doctorate 

Student’s 

Employment 

Activity

DocEmpAct Doctorate recipient primarily employed in a:

1 = Teaching Activity

2 = Research Activity

3 = Other Activity

99 = Not applicable, did not earn a doctorate degree

0 = Unknown

PRIVACY ACT

In accordance with the Privacy Act of 1974 (Public Law No. 93-579, 5 U.S.C. 552a), you are hereby notified that the Department of Education is authorized to collect 

information to implement the Ronald E. McNair Postbaccalaureate Achievement (McNair) Program under Title IV of the Higher Education Act of 1965, as amended (Pub. 

Law 102-325, Sec. 402E). In accordance with this authority, the Department receives and maintains personal information on participants in the Student Support Services 

program. The principal purpose for collecting this information is to administer the program, including tracking and evaluating participant progress. Providing the 

information on this form, including a social security number (SSN) is voluntary; failure to disclose an SSN will not result in the denial of any right, benefit or privilege to 

which the participant is entitled. The information that is collected on this form will be retained in the program files and may be released to other Department officials in the 

performance of their official duties.