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:
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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 Find your Representative

University Information:	What Texas Space Grant Institution will you be attending in the Fall? Angelo State Austin Community College Baylor University El Paso Community College Houston Community College Northwest Lamar University Laredo College 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 - Commerce 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, Houston 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 2024 2025 2026 2027 2028
GPA:	Overall GPA:     Major GPA:
Are you a past TSGC Scholarship recipient?	Yes    No    Most Recent Year 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

Briefly describe your past educational and research experiences in STEM (Science, Technology, Engineering, and Math).
(500 words or less.)


Briefly describe your future educational and career goals in STEM (Science, Technology, Engineering and Math).
(300 words or less)


Briefly describe leadership roles that you have held and describe experiences that best demonstrate your leadership abilities.
(300 words or less)


Provide information on any other experiences you have had that you believe will be an asset to this program.
(300 words or less)

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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