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 Research Fellowship

Personal Information
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 2019
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.
Research
Research Proposal: Cover page plus a proposal of no more than 4 pages -- typed, single spaced. See program guidelines for more details on the research proposal requirements.
(PDF Format)
Research Mentor
Name:
Title:
Institution:
Phone:
email:
email confirm:
My research mentor has reviewed my research proposal and agrees to serve as my mentor in the event that I am selected for this award.

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, May 31, 2019.

Other Supporting Materials
Resume:
(PDF Format)
Other Honors, awards, scholarships and/or NASA programs you have received or in which you've been involved.
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
Disability: I do not have a disability
I do not wish to identify my disability status
Vision
Missing Extremities
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?
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.