Please Note: This is a sample application for viewing purposes only. This application cycle is currently closed.

Personal Information
First Name:
Last Name:
State: Zip:
Phone: -
Curriculum Vitae/Resume:
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(PDF format only)
Educational Information
University: What Arkansas Space Grant University will you be attending in the Fall?
Current University Standing:
GPA: (4 Point Scale)
Credit Hours:
University ID:
Transcript (Unofficial or Official):
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Educational History: List the universities that you have attended not including the degree that you are currently working on. Please upload a PDF version of your transcript. If you are selected to receive the award, official transcripts may be required 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 Credit Hours Transcript
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What is the highest degree you would like to attain in the future?
What would be your probable field of study for this degree?
After completing your studies, where do you plan to work?
Describe your research interest in space and aerospace-related science.
(200 words or less.)
Describe the project that will be conducted. The description should include but not be limited to a description of the research, start and end dates, intended results.
(200 words or less.)
Identify which NASA Mission Directorate that your research supports and describe how your research will contribute to the mission of that Directorate.
(200 words or less.)
Campus Representative
email confirm:
Faculty Advisor
email confirm:
Once you have submitted your application we will email them instructions on how to submit an on-line letter of recommendation on your behalf. Please inform them that they will be receiving an email from with these instructions. Letters of recommendation are due by Monday, February 13, 2023.
Personal Information for office use only
Race: American Indian or Alaska Native
Black or African American
Native Hawaiian or Other Pacific Islander
Disability: I do not have a disability
I do not wish to identify my disability status
Missing Extremities
Other Impairments
I have a disability, but it is not listed
  Specify if not listed:
U.S. Citizenship: I am a citizen of the United States of America.
First Generation: Will you or your siblings be the first in your family to graduate from college?
Military Service: Have you ever served in the U.S. military?
Photo Release:
File Upload
(PDF format)
By uploading this file, you give NASA and the Arkansas Space Grant Consortium permission to use your photos on the website, in marketing tools, and other public forums. The form can be accessed at
I am a citizen of the United States of America
I am a full time student at an member institution
If awarded, I agree to provide , or its agents, information about my studies and/or employment on request beyond the term of the award (this is part of a NASA requirement to track long range effectiveness of the program)
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. This application cycle is currently closed.