Sponsor: South Carolina Space Grant Consortium
Program: STEM Outreach Award
Personal Information
First Name: | |
Last Name: | |
e-mail: | sample-applicant@example.com |
Address: | |
City: | |
State: | Zip: |
Phone: | - |
Curriculum Vitae/Resume: |
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(PDF format only) |
Educational Information
University: |
What South Carolina Space Grant University will you be attending in the Fall? |
Department: | |
Current University Standing: | |
Major: | |
GPA: | (4 Point Scale) |
Credit Hours: | |
University ID: | |
Transcript (Unofficial or Official): |
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Educational History: |
List the universities that you have attended not including the degree that you are currently working on. Please upload a PDF version of your transcript. If you are selected
to receive the award, official transcripts may be required for verification.
If you do not have a PDF conversion tool you can use one of these free on-line PDF converters: PDF Online - PDF Converter. To ensure that your PDF files may be properly included in your application, please ensure that they are not protected via encryption, a password, a signed certificate, or in any other manner. |
College/University | Major | Credit Hours | Transcript |
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Outreach Project
Project Title: | |
Project Term: | |
Proposal: |
In 2 pages or less that describe your intended outreach project. Please Include:
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NASA Relevance: |
We require that all of our projects involve NASA-related research. Currently, all research at NASA falls within one or more of their 4 Mission Directorates.
Please select the NASA Mission Directorate that best fits your project.
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Interest Essay: |
Write an essay (500 words or less) that describes your past activities, current interests, and future plans.
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Mentor Approval: |
I certify that my research mentor has approved the provided research proposal. |
Project Faculty Advisor: |
References
Title: | |
Name: | |
Institution: | |
Department: | |
Phone: | |
email: | |
email confirm: |
Personal Information for office use only
Gender: | Male Female |
Birthdate: | |
Ethnicity: | |
Race: | |
Person With Disability: | Yes No |
U.S. Citizenship: | I am a citizen of the United States of America. Yes No |
First Generation: | Will you or your siblings be the first in your family to graduate from college? Yes No |
Free or Reduced Lunch: | Did you qualify for subsidized school lunch? Yes No |
Military Service: | Have you ever served in the U.S. military? Yes No |
Other Information
Photo Release: |
File Upload (PDF format)By uploading this Photo Release Form, you give NASA and the SC Space Grant Consortium permission to use your photo on the website, in marketing tools, and other public forums. Please do NOT submit a photo. Sign and upload the Photo Release Form. |
Information Release: | I give permission to NASA and the SCSG to post my full name and award type online. Yes No |
Certification: | I certify that all of the information in this application is correct and that I meet all of the eligibility requirements stated. Yes No |