First Name:
Last Name:
e-mail:	sample-applicant@example.com
Alternate e-mail:
Address:
	CityState , 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
Text messaging:	Send applications updates via text message
Cell Phone:
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.
Verification of U.S. Citizenship:	I am a citizen of the United States of America

University:	What North Carolina institution of higher education will you be attending in the Fall?
Department:
Major:
Second Major/Minor:
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 Most Recent Associates BA BBA BS AB Bachelors MA MBA MS MSE Masters JD MD PhD Doctorate File Upload Previous Associates BA BBA BS AB Bachelors MA MBA MS MSE Masters JD MD PhD Doctorate File Upload Second Previous Associates BA BBA BS AB Bachelors MA MBA MS MSE Masters JD MD PhD Doctorate File Upload Third Previous Associates BA BBA BS AB Bachelors MA MBA MS MSE Masters JD MD PhD Doctorate File Upload
	What is the highest degree you would like to attain in the future? Masters Doctorate
	What would be your probable field of study for this degree? Aeronautical/Aerospace Agricultural Anthropology Architectural Architecture Art Astronomy Astrophysics Atmospheric Science Biochemistry Bioengineering Biology Botany Chemical Chemistry Civil Climatology/Meteorology Computer Computer Science Earth Sciences Economics Education Electrical/Electronic Engineering Engineering Mechanics Engineering Science Environmental Environmental Science Geography Geology Geophysics Health Science/Nutrition History Industrial Life Sciences Materials Science/Engineering Mathematics Mechanical Medicine/Medical Research Mining/Petroleum & Natural Gas Molecular/Cell Biology Nuclear Oceanography Other Philosophy Physical Sciences Physics Planetary GeoSciences Planetary Sciences Political Science/Public Policy Psychology Social Sciences Sociology Zoology
	After completing your studies, where do you plan to work? Private Industry Teaching (K-12) NASA Non-NASA Federal Agency State/Local Government Nonprofit Organization Military Consulting Undecided Other

	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 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 notices@spacegrant.net with these instructions. The deadline for submission of reference letters is Wednesday, October 18, 2023. What courses and other activities do you plan to enroll in? How will these activities enhance your STEM-teaching capabilities?
(500 words or less)

Briefly describe your educational philosophy or particular interest in your approach to teaching STEM.
(500 words or less)

How will this award impact you personally and professionally?
(300 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 STEM Pre-service Teacher Education 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

If I receive this award I will:

• Participate in a welcome webinar that will provide an overview of NASA resources
• Complete four virtual NASA professional development webinars (scheduled throughout the academic year)
• Complete two NASA lessons and participate in two share-a-thon webinar sessions to discuss best practices and cross-curricular connections
• Respond to academic and employment follow-up surveys administered as required by the federal government.

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.