Indiana Space Grant Consortium Application System

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.

Personal Information

First Name:
Last Name:
e-mail:	sample-applicant@example.com
Current Address:
	,
Congressional District:	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 Masters Fellowship Program?

Educational Information

University:

At what Indiana Space Grant Consortium Affiliate university will you enrolled during the period of this award?

Major:

Degree Objective:

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
					File Upload
					File Upload
					File Upload
					File Upload

Other Information

Resume:	File Upload (PDF format)
Career Goals	What are your short and long term career objectives (5 and 20 years)? (300 words or less)
	Answer one of the following two questions. What is the impact of the Space Program on your life? What is the impact of science, mathematics, engineering and technology on your life? (400 words or less)
Honors and Societies	Please describe any honors or awards that you have received and any societies that you are a member (includes dates and position held). (300 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. (300 words or less)

NASA Alignment

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

Optional Information

Students are strongly encouraged to provide the information requested below which is for reporting purposes only.

Ethnicity:
Race:
Birthdate:
Person With Disability:	Yes No
Are You a Veteran:	Yes No

Certification

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.

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.