Building Leaders for Advancing Science and Technology

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

Applications Due: Thursday, February 1, 2024
Frequently Asked Questions

Personal Information

First Name:
Middle Name:
Last Name:
Preferred Name:
Email:	sample-applicant@example.com
Street Address:
	, VA ZIP Code +4 Lookup
Student Phone:	( ) -
Birthdate:
Are you a US citizen or Legal Permanent Resident?	Yes No
Are you a Virginia Resident?	Yes No
What is your current grade?	8^th Grade 9^th Grade
T-shirt size:	Male adult sizes.
	How did you hear about the Building Leaders for Advancing Science and Technology? Please Describe:
Gender at Birth:	Female Male
Gender Identity:	Your responses to the following will only be used to assign housing if you are selected to participate in BLAST. It will not be shared with the scoring committee. In this application, nonbinary includes all gender identities that do not fit within the male and female binary. Female Male Non-Binary
Parent/Legal Guardian First Name:
Parent/Legal Guardian Last Name:
Parent/Legal Guardian's Work or Cell Phone:	( ) - -
Parent/Legal Guardian's email address:
Email confirmation:

Session Preference

Please rank your session preferences by selecting from the options below. Note that if you only select one session, you will only be considered for that session.

Session	1st Choice	2nd Choice	3rd Choice	4th Choice	5th Choice	Not Interested in this Session
Old Dominion University June 16-19, 2024
William & Mary June 23-26, 2024
Virginia Tech July 7-10, 2024
Radford University July 21-24, 2024
University of Virginia July 28-31, 2024

School Information

School Name:
School Address:	, VA
School Principal Name:
School Principal email:
email confirmation:
School Counselor First Name:
School Counselor Last Name:
School Counselor email:
email confirmation:
	When your application is submitted, your Counselor will receive an automated email request to verify the school-related information provided in your application. You will receive a confirmation email from notices@spacegrant.net when the verification form is received. We recommend you inform your School Counselor that they will receive an email from notices@spacegrant.net asking for this verification. It is the student's responsibility to follow-up with the School Counselor to ensure the verification form is received electronically no later than Thursday, February 8, 2024. Without the School Counselor Verification form, your application is incomplete and ineligible for consideration.
Home School:	I am home schooled

Recommendation

As part of your application packet, you are required to provide one recommendation from a teacher, school administrator or someone who can attest to your academic qualifications.

Recommender First Name:
Recommender Last Name:
Title:
School/Organization:
Recommender Phone:
Recommender email:
email Confirmation:
	When your application is submitted, your Recommender will receive an automated email requesting they complete the electronic recommendation form provided. You will receive a confirmation email from notices@spacegrant.net when the form is received. We suggest you inform your Recommender that they will receive an email from notices@spacegrant.net asking for the form to be completed. It is the student's responsibility to follow-up with the Recommender to ensure the recommendation is received electronically no later than Thursday, February 8, 2024. Without the Recommendation form, your application is incomplete and ineligible for consideration.

Student Short-Answer Responses

Use the space provided to respond to each of the following questions/statements in your own words. This is your chance to share who you are with the selection panel, so proofread and be sure to answer each question completely. All questions are required. Applications submitted with one or more missing responses will be ineligible for consideration.

Please list all extracurricular activities or elective classes you have participated in. These may be STEM-related, but they do not have to be. Please list them below; you do not have to write in complete sentences for this prompt. STEM includes Science, Technology, Engineering, and Math. (Maximum 250 words)

Describe why you wish to participate in the BLAST program and what you think you will gain from the experience. (Maximum 250 words)

Optional Information

Students are strongly encouraged to provide the information requested below. This information is collected for federal reporting purposes and is not accessible to the application scoring committee.

Ethnicity:
Race:	American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Do not wish to report
Disability:	I do not have a disability I do not wish to identify my disability status Vision Hearing Paralysis Missing Extremities Other Impairments I have a disability, but it is not listed Specify if not listed:
1^st Generation:	You are a first-generation college student if your parent(s) did not complete a bachelor's degree. Would you be a first-generation college student? Yes No

Student Certification

By applying to the project, you are acknowledging the following:

I meet the qualifications required to be considered for selection to BLAST: Virginia 8th or 9th grade student with a C+/B- minimum grade average (2.7+ GPA), an interest in STEM, and a U.S. citizen or Legal Permanent Resident.
Only complete applications will be reviewed and considered for selection. Automated emails regarding my application's status will be sent from notices@spacegrant.net to the student and parent email addresses provided in this application. The Frequently Asked Questions page of the program's website provides clarification on application status (registered, saved, submitted, or complete.)
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 BLAST.
Selected students must stay for the entirety of the program. If I am selected to attend and cannot commit to the entire program, I must decline the opportunity. If I find I am unable to fully attend after accepting the selection, I must notify the Coordinator, Veronica Warwick (vsgcblast@odu.edu) immediately to withdraw so that another student may participate.
My name, mailing/email addresses, and school may be released to U.S. and/or State Senators and Representatives.
My name, school, city and state may be released for the purposes of project participation press releases.
If I participate in BLAST, project representatives may contact me up to six years beyond my participation to learn of my college and career plans. This may 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 my personally identifiable information will not be disclosed.
I acknowledge there is extensive walking for each session and that I could be walking up to 5 miles per day.
I understand that transportation to and from the University is not provided. I understand that check-in time is between 3-4 p.m. on the first day of the session and check-out time is between 8:30-9:30 a.m. on the last day of the session.

Parent/Legal Guardian Certification

By allowing your student to apply to the BLAST program, you acknowledge:

I have reviewed and approved my child's responses and they 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 program.
I understand the submission of this application is voluntary and give permission for my student to submit the Building Leaders for Advancing Science and Technology (BLAST) application.
I understand my student's application is not eligible for consideration until it is deemed complete. Automated emails will be sent from notices@spacegrant.net to the student and parent email addresses provided in this application to communicate changes in the application status. The Frequently Asked Questions page of the program's website provides clarification on application status (registered, saved, submitted, or complete.)
I give permission for the release of my child's name, mailing/email address, and school to U.S. and/or state senators and delegates.
I give permission for the release of my child's name, school, city, and state for the purpose of project participation press releases.
My student meets the qualifications required to be considered for selection to BLAST: Virginia 8th or 9th grade student with a C+/B- minimum grade average (2.7+ GPA), an interest in STEM, and a U.S. citizen or Legal Permanent Resident.
If selected for the BLAST summer experience, I understand my child must stay for the entirety of the session they are selected to attend. If they are unable to commit to the entire program, they must decline the opportunity. If they are unable to fully attend after accepting the selection, they must notify the Coordinator, Veronica Warwick (vsgcblast@odu.edu) immediately to withdraw.
If my child participates in BLAST, program representatives may contact my child up to six years beyond participation to learn of his or her college and career plans. This may be done via email, mail, or phone. This information will be used to assist project representatives in determining the impact of the program.
I acknowledge there is extensive walking for each session and that my child could be walking up to 5 miles per day.
I understand that transportation to and from the University is not provided. I understand that check-in time is between 3-4 p.m. on the first day of the session and check-out time is between 8:30-9:30 a.m. on the last day of the session.

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.