Oregon NASA Space Grant Consortium

First Name:
Middle Name:
Last Name:
e-mail:	sample-applicant@example.com
Alternate e-mail:
Verification of US Citizenship:	I am a citizen of the United States of America
Local Address:
	, 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
Permanent Address:
	, 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
Text messaging:	Send applications updates via text message
Cell Phone:
Alternate Phone:	( ) -
Birthdate:
Residency:	Oregon     Other

University:	What Oregon Space Grant University will you be attending in the Fall? Eastern Oregon University George Fox University Oregon Institute of Technology Oregon State University Pacific University Portland State University Southern Oregon University University of Oregon University of Portland Western Oregon University
Class Standing:	Masters Student PhD Student As of March 2023
Major:
Expected Date of Graduation:
Cumulative GPA:	(for all subjects, 4 point scale)
GPA within major:	(4 point scale)
Transcript:	File Upload (PDF Format) An unofficial transcript printed from the student account of the college or university website is acceptable. If you are selected to receive this award, official transcripts may be required for verification.

Prior Educational History:
List the universities that you have attended. Please upload a PDF version of all transcripts. 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
		AA AS BA BA BBA BS AB Bachelors MA MBA MS MSE Masters JD MD PhD Doctorate			File Upload
		AA AS BA BBA BS AB Bachelors MA MBA MS MSE Masters JD MD PhD Doctorate			File Upload
		AA AS BA BBA BS AB Bachelors MA MBA MS MSE Masters JD MD PhD Doctorate			File Upload
		AA AS BA BBA BS AB Bachelors MA MBA MS MSE Masters JD MD PhD Doctorate			File Upload

Student Resume:	A summary of your career and qualifications, including relevant employment, education, extra-curricular activities, and significant accomplishments. Resume should include current contact information including email, phone, and mailing address. File Upload (PDF Format)
Statement of Interest	A brief statement describing your interest in space science/aerospace and your desire to pursue a related career in a STEM field. Describe how receiving this fellowship would benefit you and contribute to your academic and career goals and objectives. Include other information that you believe qualifies you for fellowship consideration, including awards, achievements, challenges, or personal journey that you are willing to share. (Limit: 500 words)
Research Proposal:	A statement of work written by the student in consultation with the faculty advisor that describes the key elements of the proposed research and what the student intends to accomplish. Clearly describe the research objective and methodology, including a timeline. Identify how the proposed research relates to NASA's top research priorities and has strong alignment with NASA Mission Directorates (refer to Appendix A. Agency Information and Strategic Framework). References are included in word count. (Limit: 2000 words)
Outreach and Diversity Statement :	Diversity and inclusion are top priorities for NASA, the Office of STEM Engagement, and the Oregon Space Grant Consortium. Building a more diverse STEM workforce is critical for development of a prepared future workforce to meet the growing needs of the agency and the industry. OSGC is committed to delivering programs with the intent of broadening student participation through NASA opportunities and activities. Provide a personal statement describing the importance of outreach and the impact of sharing your research and experience with the goal of inspiring and engaging the next generation of diverse learners. (Limit: 500 words)
Major Professor Letter of Support:	The applicant's current faculty mentor for the proposed research must provide a brief statement of support acknowledging the proposal submission to the OSGC Graduate Fellowship program and the requirements and deliverables associated with the award. The Statement of Support is to be included in the online application packet submitted by the student. File Upload (PDF Format)

Gender:	Male Female Do not wish to report
Ethnicity:	Hispanic or Latino Not Hispanic or Latino Do not wish to report
Race:	American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White Do not wish to report
Person With Disability:	I do not have a disability I do not wish to identify my disability status Hearing Vision Missing Extremities Paralysis Other Impairments I have a disability, but it is not listed Specify if not listed:
Have you ever served in the U.S. military?	Yes No
	Where did you hear about this opportunity?

I certify that all information in this data sheet is true and complete to the best of my knowledge. I also authorize release of information as described in the program guidelines. I understand that submitting false information will disqualify me from participation in Oregon NASA Space Grant programs and opportunities.