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



Sponsor: Oregon Space Grant Consortium

Program: OSGC Undergraduate Scholarship

Personal Information
First Name:
Middle Name:
Last Name:
e-mail:john.doe@nonexistentbox.com
Alternate e-mail:
Verification of US Citizenship: I am a citizen of the United States of America
Local Address:
,   - ZIP Code +4 Lookup
Permanent Address:
,   - ZIP Code +4 Lookup
Text messaging: Send applications updates via text message
Cell Phone:
Alternate Phone: ( ) -
Birthdate:
Residency: Oregon     Other
Educational Information
University: What Oregon Space Grant University will you be attending in the Fall?
Class Standing: As of March 2017
Major:
Expected Date of Graduation:
Cumulative GPA: (for all subjects, 4 point scale)
GPA within major: (4 point scale)
Transcript:
(PDF Format)
An unofficial transcript printed from the student account of the college or university website is acceptable.
Other Supporting Materials
Resume:
(PDF Format)
Letter of Intent: Indicate your STEM career goals as they relate to NASA's vision and how they align with one or more of the NASA Mission Directorates. How will this scholarship contribute to your goals? Describe how your career choice will benefit the STEM community at large. Include other information that you believe qualifies you for scholarship consideration.(Suggested length: One page or about 300-550 words)
Other Honors, awards, scholarships and/or NASA programs you have received or in which you've been involved.
Reference
Name:
Title:
Institution:
Phone:
email:
email confirm:
Once you have submitted your application this individual will received an email requesting their supporting material. Your application will not be complete until this information has been received. Please inform this individuals 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 Friday, June 2, 2017.
Optional Information
Students are strongly encouraged to provide the information requested below which is for reporting purposes only.
Gender:Male Female
Ethnicity:
Race: American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other
Person With Disability:Yes No
Have you ever served in the U.S. military? Yes No

Where did you hear about this opportunity?
Certification
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.

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