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?
Are you a male or female student?
Are you a high school sophomore?
Are you a Virginia Resident?
School Information
School Name:
School Address:
,
Guidance Counselor Name:
Guidance Counselor email:
email confirm:
Upon providing your current high school counselor's name and email address, he or she will be sent an electronic request to provide the following
information on official school letterhead: current GPA, class rank, and current grade level confirming eligibility in the project. 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 Wednesday, November 15, 2017.
Home School:
CTE:
Are you now enrolled or have you completed career and technology education (CTE) coursework?
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.
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:
email:
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 Wednesday, November 15, 2017 deadline.
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)
Please describe your career aspirations, extra-curricular activities,
work experiences, volunteer work, honors, awards and hobbies.
(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:
Student Certification
By applying to the project, you are acknowledging the following:
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.
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:
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.
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.
