Virginia Pilot Pathways Scholarship

First Name:
Middle Name:
Last Name:
Preferred Name:
e-mail:	sample-applicant@example.com
Birthdate:
Cell Phone:
Are you a US Citizen?	Yes    No
Are you a male or female student?	Male   Female
What is your high school grade level?	10th 11th 12th
Are you a Virginia Resident?	Yes    No

Depending on the status of the current pandemic, program participants will be required to follow guidelines set by the VSGC and the Academy site to ensure the safety of all participants. These guidelines could potentially include providing proof of vaccination, wearing masks, social distancing, and pre-program COVID testing.
Will you be able to provide proof of vaccination and booster if required? Yes    No

Name:
Relationship to Student:
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 PA PW PR RI SC SD TN TX UT VT VI VA WA WV WI WY
Cell Phone:
Email:

	The dates for the flight sessions will be take place during Fall 2022. Selected participants will be given the chance to indicate their best availability and preference to the flight school to which they are assigned. Once assigned to a specific flight school and flights have been scheduled, participants must commit themselves to this entire 40 hour set of flights in order to continue forward in the scholarship program. I confirm that I will commit to the full 40 hours of scholarship and will complete my involvement in this program if awarded. Yes   No
Do you currently have an FAA Medical Certificate?	Yes   No Students who are accepted into this program will be required to obtain an FAA Medical Certificate before they arrive at their assigned session. Are you able to obtain the medical certificate prior to the flight Academy?Yes   No Note: Typical cost for this physical is $120. Arrangements can be made to a assist students without means to cover this cost.
Will you be 16 prior to the start of your flights?	Yes   No
Have you ever participated in past VSGC Programs?	Yes   No Please list all VSGC programs and year of participation:
Please list any prior aviation experience here:

School Name:
School 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 PA PW PR RI SC SD TN TX UT VT VI VA WA WV WI WY
GPA:	Note: 3.0 GPA Required: Please attach an unofficial high school transcript with your application. Your official transcript will be requested upon selection.
Transcript:	File Upload (PDF format)
List all extra-curricular activities, organizations, and honors:

As part of your application you are required to provide two letters of recommendation from individuals who are not relatives. One reference must be from a teacher, school administrator, or counselor who can attest to your academic qualifications. The second should be a character reference from whomever you choose. When you submit your application, the application system will forward the letter of recommendation form to your selected references. Your references will submit the completed form directly to this system via an online form. You are responsible for ensuring references have been received by your chosen references, completed in a timely manner, and submitted before the deadline of Thursday, November 17, 2022.

Reference 1
Full Name:
Relationship to Student:
Institution:
Phone:
Email Address:
Confirm Email Address:
Reference 2
Full Name:
Relationship to Student:
Institution:
Phone:
Email Address:
Confirm Email Address:

After your application is submitted, both of these individuals will receive an email request from notices@spacegrant.net for this information on your behalf. Reference letters are due by Thursday, November 17, 2022. Please complete an essay in your own words using the following questions:

1. Describe yourself to us: your academic strengths, interests, and personal characteristics.
2. What kind of extra-curricular activities or hobbies have you engaged in that are meaningful to you?
3. Tell us about any past aviation experiences and goals you have towards a career in as a commercial or military pilot.
4. Explain why you wish to be awarded this scholarship 40 hours of flight time and how participating would impact your career goals as a commercial pilot.

Note: This essay is a critical component in the selection process. It is your chance to present yourself to the selection panel. Answer all questions completely in your essay. Please use approximately 500-600 words.

How did you hear about this program?
Do you have plans to pursue your private pilot's license?	Yes   No Please describe your plan

Students are strongly encouraged to provide the information requested below. This information is collected for federal reporting purposes only and is not accessible to the program's selection panel.

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

I certify that I am a U. S. citizen and that my answers are true and complete to the best of my knowledge.

If this application leads to my selection, I understand that false or misleading information in my application or interview may result in my disqualification from participation.

Student Name: I fully support my student's application to the Virginia Pilot Pathways Scholarship program. I will be responsible for transportation to and from the flight training sessions for my student.

I understand that, if selected, my student will be required to participate in Fall 2022, with specific flight times to be assigned later. Additionally, an FAA medical exam will be required prior to the start of the flying with a cost of approximately $120 if the student does not already have an FAA medical exam on file. You should review the following site (https://www.faa.gov/licenses_certificates/medical_certification/) to determine if you may have any flight restricting medical conditions before applying. If there is a financial hardship, VSGC may be able to cover the cost.

An email will be sent to the student and legal guardian's email, confirming the student's application.

Guardian's Name:

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