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

Personal Information
First Name:
Last Name:
Alternate e-mail:
CityState ,   - ZIP Code +4 Lookup Zipcode+4
Text messaging: Send applications updates via text message
Cell Phone:
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.
Verification of U.S. Citizenship: I am a citizen of the United States of America
Educational Information
University: What North Carolina institution of higher education will you be attending in the Fall?
Second Major/Minor:
University Standing as of Spring 2023:
Expected Date of Graduation:
GPA: (4 Point Scale)

Educational History: List the universities that you have attended beginning with the most recent. Only list universities where you have completed at least 10 credits hours. 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 Credits Transcript
Most Recent
Second Previous
Third Previous
What is the highest degree you would like to attain in the future?
What would be your probable field of study for this degree?
Research Mentor
Address Line 2
State and Zipcode: State
email confirm:
Once you have submitted your application we will email them 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 with these instructions. The deadline for submission of reference letters is Wednesday, March 15, 2023.
Research Project

Research Interests, Goals, and Anticipated Findings. In your own words describe the research project that you will be conducting. The description should include but not be limited to a description of the research, start and end dates, anticipated results, and how you will be working with your research mentor for the term of the award.
(1500 words or less)

Alignment of Research to NASA Mission Directorates and the NC Space Grant Strategic Plan. Identify which NASA Mission Directorate that your research projects aligns with and describe how your research will contribute to the mission of that Directorate. Describe how your research project supports the NC Space Grant mission and strategic plan.
(400 words or less)

Primary NASA Mission Directorate Alignment:
Secondary NASA Mission Directorate Alignment:

Academic and Career Interests. Describe your career interest and how this research project supports the pursuit of your academic and/or career interests.
(400 words or less)

Intended Impacts of this Award. Describe how this research project will be a springboard to pursuing your future academic and/or career interests. What new skills or information will you obtain that will impact your pursuits?
(400 words or less)
Project Location and Term
My research mentor has read and approved this project description and has agreed to supervise me while I conduct this research.

I understand that my research mentor will ask me to report on my research activities at the end of the academic year.

Other Information
List and any past or present financial aid (scholarships, grants, loans, etc.)
(250 words or less)

Have you previously received a Space Grant award?  Yes   No  
If so please describe the program and your experience.
(750 words or less)

Optional Information
for reporting purposes only
Gender: Male Female
Person With Disability: Yes No

How did you hear about the NC Space Grant Undergraduate Research Scholarship Program?
If I receive this award I will:
  • Submit a final research report to NC Space Grant.
  • Present a poster at the NC Space Grant Space Symposium in spring 2024.
  • Share research experiences in public forums or educational settings. Presentations that encourage interest in NASA-related careers and research to high school students are of particular interest to NC Space Grant.
  • Work with the North Carolina Space Grant communications team to develop and implement a plan to share research and experience, including but not exclusively on social media, in print, and on the North Carolina Space Grant website.
  • Make activity and results public via social media during and after their research, using accessible social media accounts and consistent hashtags.
  • Credit NCSG for sponsoring the activity in all printed materials (logo, social media, etc).
  • Inform the Consortium of changes of address.
  • Respond to academic and employment follow-up surveys administered by NC Space Grant as required by NASA.
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 the program announcement.
Please Note: This is a sample application for viewing purposes only. This application cycle is currently closed.