North Carolina Space Grant

First Name:
Last Name:
Email:	sample-applicant@example.com
Alternate email:
Verification of US Citizenship:	I am a citizen of the United States of America
Current Address:
	City State , 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   - ZIP Code +4 Lookup Zip CodeZip Code + 4
Cell Phone:
Alternate Phone:
Permanent Address:
	CityStateZipcode+4 , 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 - ZIP Code +4 Lookup
Congressional District:	District 1 District 2 District 3 District 4 District 5 District 6 District 7 District 8 District 9 District 10 District 11 District 12 District 13 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.

University:	What North Carolina 2- or 4-year institution of higher education will you be attending in the Fall?
Academic Program:
Second Major:
Minor:
College:
Department:
Degree Sought:	Associates BA BBA BS Bachelors
Academic Standing:	Freshman Sophomore Junior At the beginning of the Fall 2023
Expected Date of Graduation:
Current GPA:	(4 pt scale)
Future Education Plans:	Do you plan to pursue a 4-year degree? Yes   No
Educational History:	List the community colleges and universities that you have attended beginning with the institution you are currently attending. Other than your current institution, only list institutions where you have received a degree. Please upload a PDF version of your most recent academic 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 Major Degree Date Awarded GPA (4 pt scale) Transcript Most Recent Associates BA BBA BS AB Bachelors File Upload Previous Associates BA BBA BS AB Bachelors File Upload Second Previous Associates BA BBA BS AB Bachelors File Upload Third Previous Associates BA BBA BS AB Bachelors File Upload

	Reference
Name:
Title:
Institution:
Department:
Address:	Address Line 2
City:
State and Zipcode:	State 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 Zipcode
Phone:
Email:
Email confirm:

Once you have submitted your application your reference will receive an email requesting their supporting material. Your application will not be complete until this information has been received. Please inform your reference that they will receive an email request from notices@spacegrant.net for this information on your behalf. The deadline for submission of reference letters is Wednesday, October 18, 2023. Please answer the following questions describing your background and interests in STEM (Science, Technology, Engineering and Mathematics).

What STEM-related course(s) or program(s) would you like to study? What interests you about them?
(400 words or less.)


What makes you interested in NASA, commercial space, aviation/aeronautics, or research being conducted in the ISS (inclusive of astronaut health or earth science)?
(400 words or less.)


How will this scholarship impact your academic or career pathways (beyond financial support)?
(400 words or less.)


Describe any STEM-related extra-curricular activities in which you have participated (e.g., clubs, teams, camps, mentoring, jobs, internships, etc.) that may have prepared you to fulfill your scholarship requirements.
(400 words or less.)


We encourage you to visit our website, https://ncspacegrant.ncsu.edu/, to learn more about the NC Space Grant, and our additional scholarship, fellowship and internship opportunities.

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

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

	How did you hear about the MSI STEM Pathways Scholarship Program?
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 Do not wish to report
Birthdate:
Person With Disability:	I do not have a disability I have a disability I choose not to disclose

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.