Oregon NASA Space Grant Consortium

Awards are offered in the following categories. Select the discipline in which you are currently enrolled.

Award Category:

STEM Education: Preparation to be a classroom teacher or an informal educator in a STEM field. Life Science: The study of living organisms-includes biology, anatomy, astrobiology, zoology, botany, microbiology, physiology, biochemistry, neuroscience, and other related areas. Physical Science: The study of non-living organisms-includes physics, astronomy, chemistry, earth science. Mathematics Engineering and Technology Non-STEM field with a significant connection to aerospace or space science (community college and undergraduate programs only)
Please indicate the specific field:

• Student is enrolled in a minimum of 12 credit hours per term at an affiliated 4-year institution during the 2023-2024 academic year.
• Student is enrolled in an MAT program with a STEM focus.
• Student maintains good academic standing.
• Student is a U.S. Citizen.

First 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:
	Local Address City , Local Address state 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  Local address zipcode - Local address zipcode + 4 ZIP Code +4 Lookup
Permanent Address:
	Permanent Address City , Permanent Address state 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  Permanent address zipcode - Permanent address zipcode + 4 ZIP Code +4 Lookup
Cell Phone:	(cell phone area code ) cell phone prefix - cell phone suffix
Birthdate:
Residency:	Oregon Other

	What Oregon Space Grant Institution 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
Major:
Expected Date of Graduation:
Cumulative GPA::	(for all subjects, 4 pt scale)
GPA within major::	(4 pt 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.
Resume:	File Upload (PDF format)

The letter should specifically address your qualifications and merit for this scholarship.

First Name:	Reference first name
Last Name:	Reference last name
Title:	Reference title
Institution:	Reference institution
Phone:	Reference phone
email:	Reference email
email confirm:	Reference email confirmation

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 individual that they will receive an email request from notices@spacegrant.net for this information on your behalf. The deadline for submission of the letter of recommendation Friday, June 16, 2023. Submit a letter of intent that includes the following: (1-2 pages, single spaced, no more than 12 pt font)

1. What inspired you to become a teacher and where are you in your pre-service educator path?
2. Describe your vision as an educator to help build students' STEM identity.
3. Describe how this scholarship might prepare you to incorporate NASA content in the classroom.
4. Indicate your STEM career goals as they relate to NASA's vision and how they substantively align with one or more of the NASA Mission Directorates. See Appendix A. Agency Information and Strategic Framework. For a detailed description of NASA's mission, history, and future plans, visit the following NASA website: http://www.nasa.gov/about/highlights/what_does_nasa_do.html
5. Include other information that you believe qualifies you for scholarship consideration. This may include extracurricular activities, awards, volunteer opportunities, soft skills, challenges, personal journey, etc.

Letter of Intent:
(PDF Format) Students are strongly encouraged to provide the information requested below which is for reporting purposes only.

	How did you hear about the OSGC Dr. Nancy Squires Memorial Scholarship - Pre-Service Educator?
Gender:	Female Male Do not wish to report
Ethnicity:	Hispanic or Latino Not Hispanic or Latino
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:

I certify that all of the information contained in this application is complete and correct and that I meet all of the eligibility requirements stated in this application.