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Commonwealth STEM Industry Internship Program

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.

Application Information Form

For CSIIP eligibility requirements please visit https://vsgc.odu.edu/csiip/

For STEM Takes Flight NASA Research Experiences please visit https://vsgc.odu.edu/stemtakesflight/ and click on student opportunities.

Note: Exiting military and veterans are encouraged to apply. Exceptions to the eligibility requirements may be made on a case-by-case basis.

Personal Information

First Name:

Middle Name:

Last Name:

email:

sample-applicant@example.com

Alternate email:

Citizenship:

I am a citizen of the United States or
I am a Permanent Resident of the United States.

Dual Citizenship:

I am a Dual Citizen. Yes No

Current Address:

,		- ZIP Code +4 Lookup
City	State	ZIP Code

Cell Phone:

( ) -

Alternate Phone:

( ) -

Permanent Address:

, - ZIP Code +4 Lookup

We conduct intern searches based on distance from company to student address. Alternate addresses should be used when you have additional addresses in Virginia where you can obtain housing (i.e., a friend, relative). This should greatly increase your chances of being considered for an internship.

Alternate Address:

(Alternate addresses expand options for internships.)

, - ZIP Code +4 Lookup

Alternate Address:

, - ZIP Code +4 Lookup

Federal Congressional District:

To find your Congressional District visit the House of Representatives Website.

State Congressional District:

Virginia State Delegate:
Virginia State Senator:
To find your district number information: General Assembly Website
Please enter your permanent home address in this online form to find your Virginia legislators. If your permanent residence is outside of Virginia, please enter your school address in the form.

Educational Information

I am pursuing a:

University/Community College:

Are you attending a University or a Community College? University Community College

Current University/College:

If your institution is not listed above please enter here.

Academic Standing:

at time of application

Explain:

Status:

at time of application

Degree Sought:

Explain:

Expected Date of Graduation:

Discipline of Study:

Select the broad discipline area for your field of study first. The "Majors" box will then be populated accordingly. Then select your major. If you can't find your major, please notify the VSGC at csiip@spacegrant.org

Major:

Please choose the major that most closely matches your major. If you feel that none of these closely match your major please email VSGC.

Double Major/Minor:

GPA:

on a 4 point scale (including most recent term)
Non-Degree Technical Certification Program with no GPA

Resume:

Note: Resumes should include the student's contact information, as well as information addressing internship objectives, education, employment history, relevant skills and abilities, STEM programs and experiential activities in which they have participated, volunteer activities, honors received (scholarships and other awards), and references. There are many resume writing resources on the Internet. A list of resources is available under the "Students" tab of the CSIIP website.

File Upload

(PDF format)
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.

Educational History:

List the colleges and universities that you have attended beginning with the institution you are currently attending. Other than your current institution, only list colleges and universities where you have completed 10 or more credit hours. Please upload a PDF version of your most recent transcript. Submitted transcripts may be unofficial. If you are selected to receive the award, official transcripts will 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	Transcript
	File Upload (PDF Format)
	File Upload (PDF Format)
	File Upload (PDF Format)
	File Upload (PDF Format)

References

One reference letter should be a faculty member and the other can be a faculty member or previous employer.

	Reference #1
Name:
Title:
Institution:
Department:
Address:
City:
State and Zipcode:
Phone:
email:
email confirm:

Reference #2

Once you have submitted your application, both of these individuals will automatically receive an email requesting their supporting material. Your application will not be complete until this information has been received. Please inform both of these individuals that they will receive an email request from notices@spacegrant.net for this information on your behalf. While the reference will receive an email reminder, it is the applicant's responsibility to ensure that required references are submitted.

Supplemental Information

Would you be willing to relocate to obtain an internship experience? Yes No

Can you speak, read, or write a language other than English? If yes, please list below and indicate proficiency. Yes No
Language: Proficiency:
Language: Proficiency:

Computer Skills:

Please list your specific computer hardware & software skills: i.e.-MATLAB plus your level of proficiency
(200 words or less)

Additional Skills:

Please list any additional certifications or licenses obtained including but not limited to advanced manufacturing areas.
(200 words or less)

Essay:

Please provide an essay that includes a self-introduction, statement of academic and career goals, STEM related programs and experiences, previous work history and other pertinent data.
(500 words or less)

Please list your relevant work, research, internship (including Virginia Space Grant Consortium and NASA programs), and co-op experience.

Company/University	Short Description	Location	Inclusive Dates

Demographic Information

This data is for VSGC program impact reporting purposes only and will not be shared with potential employers.

Submission of this information is voluntary. It will not be used for selection purposes.

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

Certification

	I certify that all information contained in this application and the attached documents is accurate to the best of my knowledge.
	If selected for an internship, I agree to fully participate in the CSIIP evaluation process by completing surveys and providing information that can improve the program. I will receive annual surveys for longitudinal track to my next academic or career step.
	If selected for an internship, I understand that I will be employed by the hiring company and the wages or stipend for my internship be paid directly by the company. I agree to act in an ethical and professional manner, and agree to abide by any company polices or procedures associated with any company that hires me for an internship.
	I also agree to hold the VSGC harmless for any outcome associated with use of this website or in participating in any internship associated with this program.

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.