Astronaut outside Space Shuttle in orbit

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

Personal Information
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:
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Permanent Address:
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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 2023
Major:
Expected Date of Graduation:
Cumulative GPA: (for all subjects, 4 point scale)
GPA within major: (4 point scale)
Transcript:
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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.
Other Supporting Materials
Resume:
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Letter of Intent: Includes the following:
  • Describe the Plan of Study for your STEM academic goals throughout your undergraduate program.
  • Express your interest in a space science/aerospace related career.
  • Briefly describe your skill sets and qualifications in context of this opportunity.
  • Describe how this opportunity would benefit you and contribute to your academic and career goals and objectives.
(Suggested length: One page or about 300-550 words)
Project Description: Includes the following:
  • State the research topic you have selected to review and provide an overview of the topic. Include why you are interested in this particular subject.
  • Concisely state how the topic substantively aligns with one or more of NASA's Mission Directorate's top priorities and/or how it speaks to a specific challenge facing one of NASA's current missions.
NOTE: Topics should be specific/narrow in scope. If selected for a STARR award, students should be prepared to offer insight into the contributions of the research and demonstrate interdisciplinary applications and how the research could potentially extend to other areas of science or engineering relating to NASA's top priorities and missions.

See Appendix A of the Program Guide. Agency Information and Strategic Framework and Appendix B. Research Priorities for NASA Mission Directorates.

Timeline and Milestones: Develop a timeline for your project that includes milestones and measurable outcomes. Refer to the Dates and Deadlines: Deliverables section for associated deadlines. Timelines are tools that help researchers stay on track to complete a project in the allotted time and should be shared with faculty advisors to ensure project deadlines are met in a timely manner. (Suggested length: One page or about 300-550 words)
Faculty Advisor Statement of Support:
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Please upload a letter of support from your faculty advisor.
Reference (Optional)
Name:
Title:
Institution:
Phone:
email:
email confirm:
If you choose to include a letter of recommendation, once you have submitted your application this individual will received an email requesting their supporting material. 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, November 10, 2023.
Demographic Information
Gender: Male Female Do not wish to report
Ethnicity:
Race:







Disability:








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.