First Name:
Last Name:
e-mail:	sample-applicant@example.com
Alternate e-mail:
Birthdate:
Address:
City:
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 Zip:
Text messaging:	Send applications updates via text message
Cell Phone:
Phone:	-
Federal Congressional District:	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 Find your Representative

University Information:	What Texas Space Grant Institution will you be attending in the Fall? Angelo State Austin Community College Baylor University East Texas A&M University (TAMU Commerce) El Paso Community College Houston Community College Lamar University Laredo College LeTourneau University Lone Star College McLennan Community College Prairie View A&M University Rice University San Jacinto College South Texas College Southern Methodist University St. Edwards University Stephen F. Austin State University Sul Ross State University Tarleton State University Texas A&M International University Texas A&M University Texas A&M University - Corpus Christi Texas A&M University - Kingsville Texas A&M University Texarkana Texas Christian University Texas Southern University Texas State University - San Marcos Texas Tech University Texas Woman's University Trinity University University of Dallas University of Houston University of Houston, Clear Lake University of Houston, Downtown University of North Texas University of St. Thomas University of Texas at Arlington University of Texas at Austin University of Texas at Dallas University of Texas at El Paso University of Texas at San Antonio University of Texas at Tyler University of Texas Health Science Center, San Antonio University of Texas Medical Branch, Galveston University of Texas Permian Basin University of Texas Rio Grande Valley University of Texas Southwestern Medical Center Why is my university not listed?
Department:
University Standing as of 9/1/2024:	Sophmore at 2 Year College Sophmore at a 4 Year Institution Junior Senior 1st or 2nd Year Medical Student
Expected Date of Graduation:	Spring Summer Fall 2025 2026 2027 2028 2029 2030
GPA:	Overall GPA:     Major GPA:
Are you a past TSGC Scholarship recipient?	Yes    No    Most Recent Year 2024-25 2023-24 2022-23 2021-22 2020-21 2019-20 2018-19 2017-18 2016-17 2015-16 2014-15 2013-14 2012-13 2011-12 2010-11 2009-10 2008-09 2007-08 2006-07 2005-06 2004-05 2003-04 2002-03 2001-02 2000-01 1999-00 1998-99 1997-98 1996-97 1995-96 1994-95 1993-94 1992-93 1991-92 1990-91

Educational History: List the universities that you have attended beginning with the most recent. Only list universities where you have completed at least 10 credits hours. Please upload a PDF version of your transcript. If you are selected to receive the award, official transcripts will 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	Credits Completed	Transcript
			File Upload
			File Upload
			File Upload
			File Upload

Describe why you want this STEM (Science, Technology, Engineering, and Math) scholarship and include the following
(1000 words or less)

• Past experiences in STEM and space exploration
• Leadership roles and experiences that demonstrate your abilities
• Any other experiences you believe would be an asset to this program
• Future educational and career goals

Name:
Title:
Institution:
Phone:
email:
email confirm:
	Once you have submitted your application we will email them instructions on how to submit an on-line letter of recommendation on your behalf. Please inform them that they will be receiving an email from notices@spacegrant.net with these instructions.

(for reporting purposes only)

Gender:	Male Female
Ethnicity:	Hispanic or Latino Not Hispanic or Latino
Race:	American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Do not wish to report
Person With Disability:	I do not have a disability I have a disability I choose not to disclose
	How did you hear about the STEM (Science, Technology, Engineering, Math) Columbia Crew Memorial Scholarship?
Are you a US military veteran?:	Yes No

Verification of U.S. Citizenship:	I am a citizen of the United States of America
Certification:	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.

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

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