Virginia Space Coast Scholars

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

Sponsor: Virginia Space Coast Scholars

Program: Virginia Space Coast Scholars

Applications Due: Sunday, October 17, 2021

Students may only apply to one Virginia Space Grant Consortium education program per year.

Frequently Asked Questions

Personal Information

First Name:
Middle Name:
Last Name:
Preferred Name:
e-mail:	john.doe@nonexistentbox.com
Home Address:
	,
Home Phone:	( ) -
Birthdate:
Parent/Legal Guardian:	My parent/legal guardian is a civil servant or contractor at NASA Wallops Flight Facility
Parent/Legal Guardian's Work or Cell Phone:	( ) - -
Parent/Legal Guardian's email address
Email confirm
Are you a US Citizen?	Yes No This program is open to U.S. citizens and Lawful Permanent Residents.
Are you a male or female student?	Male Female
Are you a high school sophomore?	Yes No
Are you a Virginia Resident?	Yes No

School Information

School Name:
School Address:
	,
School Counselor Name:
School Counselor email:
email confirm:
	Once you have submitted your application, the system will email an electronic request to provide the following information from your School Counselor: current GPA and current grade level confirming eligibility in this program. Please inform this individual that he or she will be receiving an email from notices@spacegrant.net with instructions. Note: It is the responsibility of the student to follow-up with the person who is providing the verification information to ensure that it is received electronically by Tuesday, October 19, 2021.
Home School:	I am home schooled
CTE:	Are you now enrolled or have you completed career and technology education (CTE) coursework? Yes No If you answered yes above, please list the CTE courses that you have taken.
Post High-School Education:	What are your higher education plans after high school graduation? Please check all that apply. No Plans Career and/or Technical School Community College Four-year College Graduate school

Recommendation Letter

As part of your application packet you are required to provide one letter of recommendation from a teacher, school administrator or someone who can attest to your academic qualifications.

Name:
Title:
Institution:
Phone:
Recommender email:
Recommender email confirm:
	Once you have submitted your application, the system will email this person 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. Note: It is the responsibility of the student to follow up with the person who is providing a letter of recommendation to ensure the recommendation is submitted electronically by the Tuesday, October 19, 2021 deadline.

Legislative District Information

	Look up your U.S. Representative
Congressional District:
	Look up your Virginia Delegate and Senator
State Delegate District:
State Senate District:

Other Information

Explain why you wish to participate in the program and why you would be successful. Describe personal characteristics, strengths and interests to support your explanation.
(750 words or less)

How did you hear about the Virginia Space Coast Scholars?

Optional Information

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:
Race:
Person With Disability:	Yes No What in-person physical accommodations are needed for your disability?

Student Certification

By applying to the project, you are acknowledging the following:

I am a 10^th grade student (sophomore) in high school
The responses submitted on this application are true, complete, and correct to the best of my knowledge and belief and are made in good faith. I understand that a knowing and willful false statement on this application will forfeit my participation in the project.
Release of name, mailing address, and school to U.S. and/or State Senators and Representatives.
Release of name, school, city, and state for purposes of project participation press releases.
Personal responsibility for submission of required online assignments and a final project; adhering to the due dates posted on the website.
This program is open to U.S. citizens and Lawful Permanent Residents.
All assignments, including the final project, will be completed using the honor system.
Online assignments will be graded by certified teachers using the rubric(s) posted on the website.
If my participation is successful, project representatives will contact me to up to six years beyond my participation to learn of my college and career plans. This will be done via email, mail, or phone. This information will be used to assist project representatives in determining the impact of the project. I understand my personal identifiable information will not be disclosed.

Parent/Legal Guardian Certification

By your child applying to the project, you are acknowledging the following:

My child is a 10^th grade student (sophomore) in high school
I give permission for my student to submit the Virginia Space Coast Scholars application and participate in the on-line community, and summer experience if selected.
The submission of this application is voluntary and I have reviewed and approved my student responses.
I give permission for the releases of my child's name, mailing address and school to my child's U.S. and/or State Senators and Representatives.
I give permission for the release of my child's name, school, city, and state for purposes of project participation press releases.
The responses submitted on this application are true, complete, and correct to the best of my knowledge and belief and are made in good faith. I understand that a knowing and willful false statement on this application will forfeit my child's participation in the project.
My child is personally responsible for submission of required online assignments and final project; adhering to the due dates posted on the website.
This program is open to U.S. citizens and Lawful Permanent Residents.
All assignments, including the final product, will be completed using the honor system.
Online assignments will be graded by certified teachers using the rubric(s) posted on the website.
If my child participates, project representatives will contact my child up to six years beyond participation to learn of his or her college and career plans. This will be done via email, mail or phone. This information will be used to assist project representatives in determining the impact of the project. I understand personal identifiable information will not be disclosed.

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

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