Please Note: This is a sample application for viewing purposes only. To apply to this program please visit the application "New User Registration" page and register with the system.

Personal Information
First Name:
Middle Name:
Last Name:
Permanent e-mail:
Current Address:
Text messaging: Send applications updates via text message
Cell Phone:
Permanent Home Address:
High School Name:
High School City/State/Zip , -
Congressional District:
Please enter the U.S. Congressional District of your high school zip code". You may use this website to find your district: House of Representatives Website.
Country of Birth:
File Upload
(PDF format)
The resume should include a short summary of education, training and accomplishments both inside and outside the educational world.
Educator Scholar:Are you applying to be a Teacher Educator Scholar? Yes No
Educational Information
University: What Alabama College/University will you be attending in the Fall
Overall GPA:
Academic Standing: At beginning of next school year
Target Degree:
Expected Date of Graduation:
After completing your studies, where do you plan to work?
Educational History: List the universities that you have attended beginning with the institution you are currently attending. Other than your current institution, only list universities where you have received 10 or more credit hours. Please upload a PDF version of your transcript. Official transcripts may be requsted for verification. If you do not have a PDF conversion tool you can use one of these free on-line PDF converters: PDF Online - PDF Converter.

To ensure that your PDF files may be properly included in your application, please ensure that they are not protected via encryption, a password, a signed certificate, or in any other manner.
College/University Major Credits Transcript
File Upload
File Upload
File Upload
File Upload
Faculty Advisor
State and Zipcode:
email confirm:
Once you have submitted your application this individual will received an email requesting their supporting material. Your application will not be complete until this information has been received. Please inform this individuals that they will receive an email request from for this information on your behalf. The deadline for submission of reference letters is Monday, March 4, 2024.
Other Information
Please describe your short and long term career goals (5 and 20 years).
(500 words or less)
Submission:New  Renewal
Proposed Start Date:
STEM Outreach Statement In your own words, describe your past educational and research experiences in STEM (Science, Technology, Engineering, and Math). Include any leadership roles that you have held and describe experiences that best demonstrate your leadership abilities. While describing your leadership abilities include how you could use these for K-12 outreach (500 words or less).

Optional Information
Students are strongly encouraged to provide the information requested below which is for reporting purposes only.
Gender: Male Female Do not wish to report


  Specify if not listed:

How did you hear about the Alabama Space Grant Consortium Scholarship Program?
Person With Disability:Yes No
I am a citizen of the United States of America
I certify that I am or will be a full-time undergraduate student at one of the ASGC universities.
I certify that all of the information contained in this application is complete and correct and that I meet all of the eligibility requirements stated in this application.
Please Note: This is a sample application for viewing purposes only. To apply to this program please visit the application "New User Registration" page and register with the system.

Return to the Alabama Space Grant Website