North Carolina Space Grant

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:

Academic Standing:

At the beginning of the Fall 2024

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					File Upload
Previous					File Upload
Second Previous					File Upload
Third Previous					File Upload


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 , - ZIP Code +4 Lookup Zip CodeZip Code + 4
Cell Phone:
Alternate Phone:
Permanent Address:
	CityStateZipcode+4 , - ZIP Code +4 Lookup
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.

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

	How did you hear about the MSI STEM Pathways Scholarship Program?
Gender:	Male Female
Ethnicity:
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