The David T. Kearns Center for Leadership and Diversity in Arts, Sciences, and Engineering
Kearns Scholars Application Form
Full Name
*
First Name
Last Name
Preferred Name
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
UR E-mail
*
example@u.rochester.edu
Personal E-mail
*
example@gmail.com; example@yahoo.com, etc.
Student ID
*
Intended Major
*
Expected Graduation Year
*
Please check all groups with which you identify.
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First-Generation College
Low-Income
Black/African-American
Native American
Hispanic
Other
We know you are a freshman or sophomore, but have you thought about pursuing a graduate degree? If so, which degree would you like more info about?
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PhD
MD
JD
Masters
Have not thought about it
Are you currently, or were you, a member of any of the following programs? Check all that apply
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ECO
Talent Search
Upward Bound
HEOP
Gates Millennium
POSSE
Not Applicable
Other
What services would you be interested in utilizing at the Kearns Center? Check all that apply.
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Advising
Student Focused Workshops
Potentially Credit-Bearing Seminar Class
Textbook Lending or Purchasing
Potential Funding for Summer Courses
Access to a Computer Lab with Free Printing
Connections to Upper Class Students
What other types of programs or services would you like to see offered by the Kearns Center this year?
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The Kearns Center will be holding a number of workshops, seminars, social events, etc. Please include some dates/times that would work with your schedule/would be most convenient for you to attend (ex. Thursdays 5-7).
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Please use this space to share information about your goals and motivations for being a Kearns Scholar.
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Submit
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