First Name:
Last Name:
e-mail:	sample-applicant@example.com
Current Address:
	, AK AL AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY
Congressional District:	District 1 District 2 District 3 District 4 District 5 District 6 District 7 District 8 District 9 To find your Congressional District visit the House of Representatives Website.
	If your permanent home address is out of state please choose the congressional district for your school.
	How did you hear about the INSGC Doctoral Fellowship Program?

University:	At what Indiana Space Grant Consortium Affiliate university will you enrolled during the period of this award? Anderson University Ball State University Indiana State University Indiana University Indiana University/Purdue University Indianapolis Purdue Polytechnic Columbus Purdue University Purdue University Fort Wayne Purdue University Northwest Taylor University Trine University University of Evansville University of Southern Indiana Valparaiso University
Major:
Degree Objective:	JD MD PhD Doctorate
Expected Date of Graduation:

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 a degree. Please upload a PDF version of your transcript. 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	Major	Degree	Date Awarded	GPA (4 pt scale)	Transcript
		AA AS BA BA BBA BS AB Bachelors MA MBA MS MSE Masters JD MD PhD Doctorate			File Upload
		AA AS BA BBA BS AB Bachelors MA MBA MS MSE Masters JD MD PhD Doctorate			File Upload
		AA AS BA BBA BS AB Bachelors MA MBA MS MSE Masters JD MD PhD Doctorate			File Upload
		AA AS BA BBA BS AB Bachelors MA MBA MS MSE Masters JD MD PhD Doctorate			File Upload

Title:
Research Statement	File Upload (PDF format) The research statement, written by the student, in consultation with the advisor, should describe: the key elements of the proposed research; what he/she intends to accomplish; and, identify any aerospace application of the proposed research activity. The selection committee is made up of university faculty in a variety of disciplines. Applicants should present their proposed research in a form that will be understandable to a range of readers.
	Please provide a brief summary of your research project and goals, in a non-technical language, for use in a public website, news media requests, and in NASA reports. (450 words or less)
	Have you previously received any other Indiana Space Grant Consortium funding?  Yes   No   If so please describe the program and your experience. (450 words or less)

Please indicate below how this work aligns with NASA's Mission Directorates

Aeronautics Research Mission Directorate Advanced Air Vehicles Airspace Operations and Safety Integrated Aviation Systems Transformative Aeronautics Concepts	Human Exploration & Operations Mission Directorate Human Research Space Life Science Physical Science Research Engineering Research
Science Mission Directorate Astrophysics Earth Science Heliophysics Planetary Science	Space Technology Mission Directorate Transformative Crosscutting Technologies Technology Research and Development Challenges

Please describe how your work is aligned with NASA's Mission Directorates
(500 words or less)
INSGC encourages students to experience NASA-related research and career opportunities first-hand at NASA Centers or industry visits. Are you interested in receiving additional funding for expenses related to visiting a NASA Center or relevant industry (amount dependent upon location)? Yes    No Students are strongly encouraged to provide the information requested below which is for reporting purposes only.

Gender:	Male Female
Ethnicity:	Hispanic or Latino Not Hispanic or Latino
Race:	American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
Birthdate:
Person With Disability:	Yes No
Are You a Veteran:	Yes No

I am a citizen of the United States of America

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.

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