How did you hear about the Building Leaders for Advancing Science and Technology?
Session Preference
If you are selected to participate in BLAST, which session would you prefer?
School Information
School Name:
School Address:
Grade Report:
You must upload a copy of your grade report, report card or transcript.
(PDF format)
Helpful Suggestion: If you have a copy of a document that is not in an electronic format, you will need to scan and save the document.
With some operating systems, you can save that file as (Save As) a .PDF file. If you do not have that capability, there are several
free online programs to allow you to convert the file to a .PDF document. Your school guidance office or computer lab should have a
scanner that you may use. Another option is to go to your local library or an office supply store, and they usually offer scanning
services for a small fee. If you have problems, ask your teacher or school office for help.
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 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.
Recommendation Letter
As part of your application packet you are required to provide one letter of recommendation from a teacher, school administrator
or someone who can attest to your academic qualifications.
Name:
Title:
Institution:
Phone:
email:
email confirm:
Once you have submitted your application, the system will email this person 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 notices@spacegrant.net
with these instructions.
Note: It is the responsibility of the student to follow up with the person
who is providing a letter of recommendation as many times as necessary to ensure the recommendation is
submitted electronically by the Monday, February 12, 2018 deadline. You will receive an email indicating the recommendation has been submitted.
Essay
In your own words please,
Explain why you wish to participate in the BLAST program and how participating would impact your life.
Describe yourself to us --your interest in science, technology, engineering and math (STEM).
Tell us about STEM courses or any other courses you have taken that have interested you and why.
Describe your academic strengths and interests and personal characteristics.
What kind of extra-curricular activities or hobbies have you engaged in related or un-related to STEM?
Be sure to address each item of the essay.
(750 words or less)
Note: This essay is a critical component in the selection processs. It is your chance to present yourself to the selection panel. Answer these questions completely.
Students are strongly encouraged to provide the information requested below. This information is collected
for federal reporting purposes only and is not accessible to the program's selection panel.
Ethnicity:
Race:
Person With Disability:
1st Generation:
Will you be a first generation college student which means you are the first in your family to attend a four-year college/university to attain a bachelor's degree?
Student Certification
By applying to the project, you are acknowledging the following:
The responses submitted on this application are true, complete, and correct to the best of my knowledge and belief and are made in good faith. I understand that a knowing and willful false statement on this application will forfeit my participation in the project.
Students will be selected for the summer session experience based on the following criteria: completion of application by the deadline, essay content, recommendation letter, and minimum grade average of at least a C+, and students who have not had access to STEM enrichment activities.
Efforts will also be made to ensure geographic and demographic diversity of selected participants as well as reaching students who have not had access to STEM enrichment activities.
Should I be selected for the summer experience, I will be available to attend one of these sessions: Session 1 is June 17-20 at Old Dominion University; Session 2 is July 8-11 at University of Virginia; Session 3 is July 15-18 at Virginia Tech; and Session 4 is July 29-August 1 at the University of Virginia.
I understand that my child must stay for the entirety of the program for the session he/she selects.
If I participate in BLAST, project representatives will contact me to up to six years beyond my participation to learn of my college and career plans. This will be done via email, mail, or phone. This information will be used to assist project representative in determining the impact of the project. I understand my personally identifiable information will not be disclosed.
I acknowledge that there is extensive walking for each session and that I understand that I could be walking at least 3 -- 5 miles per day.
Parent/Legal Guardian Certificatio
By your child applying to the project, you are acknowledging the following:
I understand personally identifiable information will not be disclosed.
I give permission for my student to submit the Building Leaders for Advancing Science and Technology application and participate in the summer experience if selected.
The submission of this application is voluntary and I have reviewed and approved my child's responses.
The responses submitted on this application are true, complete, and correct to the best of my knowledge and belief and are made in good faith. I understand that a knowing and willful false statement on this application will forfeit my child's participation in the project.
Students will be selected for the summer session experience based on the following criteria: completion of application by the deadline, essay content, recommendation letter, and minimum grade average of at least a C+, and students who have not had access to STEM enrichment activities.
Efforts will also be made to ensure geographic and demographic diversity of selected participants as well as reaching students who have not had access to STEM enrichment activities.
Should my child be selected for the summer experience, she/he will be available to participate in one of the following sessions: Session 1 is June 17-20 at Old Dominion University; Session 2 is July 8-11 at University of Virginia; Session 3 is July 15-18 at Virginia Tech; and Session 4 is July 29-August 1 at the University of Virginia.
I understand that my child must stay for the entirety of the program for the session he/she selects.
If my child participates, project representatives will contact my child up to six years beyond participation to learn of his or her college and career plans. This will be done via email, mail or phone. This information will be used to assist project representatives in determining the impact of the project. I understand personally identifiable information will not be disclosed.
Should my child be selected for the summer experience, I understand check-in is from 3-4 p.m. and check-out is from 8:30 -- 9:30 a.m. and that I must provide transportation to and from the University check-in and check-out.
An email will be sent to the student and parent/legal guardian's email, confirming the student's application .
Please Note: This is a sample application for viewing purposes only. This application cycle is currently closed.
