Oregon NASA Space Grant Consortium

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:
	, 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

College:	What Oregon Space Grant Institution are you attending? Lane Community College Linn Benton Community College Oregon Coast Community College Portland Community College - Cascade Campus Portland Community College - Rock Creek Campus Portland Community College - Southeast Campus Portland Community College - Sylvania Campus Southwestern Oregon Community College
Major:
Cumulative GPA:	(for all subjects, 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.

What are your interests in STEM and what areas would you like to explore in your academic career?
(250 words or less)

How do your academic interests substantively align with the research priorities of one or more of the NASA Mission Directorates (see Appendices A and B)? Please be as specific as possible.
(250 words or less)

Explain the motivation for your unique research idea or describe what about your mentor recommended project interested you?
(250 words or less)

For many community college students, participating in research is a new experience that can help shape your expectations of a STEM career. Briefly describe what research experiences you may have already participated in, or what insights you hope to gain by participating in your first research experience with the SCORE program.
(250 words or less)

Research/Project Proposal

A 2-4 page proposal is required, and must include (see Appendix C for template): Cover Page: Include project title and student and faculty mentor's contact information. Research Problem or Project Overview: Provide a clear description of your research problem or a detailed overview of the project you are proposing. Relationship to NASA's Mission: Describe how your problem or project relates to NASA's overall mission (see Appendices A and B). Goals: Describe the goals to be achieved with your research project. Experimental design or project plan: Clearly explain the design of the experiment or plan of the project you are proposing. References: Cite sources for project-related information. Project Timeline: Provide a realistic and attainable timeline for completion of your proposed project. Project should be completed within one academic term. Estimate of Weekly Time Commitment: Provide an estimate of how many hours you anticipate working on your project per week and an explanation of how this will fit into your personal schedule. Proposals should be single-spaced, using standard 8½ x 11 paper, in font not smaller than 12-point with a minimum of 1" margins. All pages must be numbered sequentially. Proposals must be signed by the OSGC Affiliate Representative from the student's institution. See Appendix C for the proposal template. File Upload (PDF Format)

Mentor Statement of Support

The faculty mentor must write a supporting letter, describing how the student will contribute to the research or project, indicating support for the proposal, and demonstrating clear understanding of the role of SCORE Mentor. The letter of support should be included with the student's application packet. 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.