NASA West Virginia Space Grant Consortium

First Name:
Middle Initial:
Last Name:
e-mail:	sample-applicant@example.com
Secondary email:
Current 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 Code: - ZIP Code +4 Lookup
Text messaging:	Send applications updates via text message
Cell Phone:
Permanent 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 Code: - ZIP Code +4 Lookup
Home Phone:	( ) -
Have you served in the United States Armed Forces? Yes    No

College/University:	Which affiliate of West Virginia Space Grant are you currently attending? Bethany College Bluefield State University Fairmont State University Glenville State University Marshall University Shepherd University West Liberty University West Virginia State University West Virginia University West Virginia University Institute of Technology West Virginia Wesleyan College Wheeling University
Major Field of Study:
Minor Field of Study:	(if any)
Overall GPA:	(4 point scale)
Departmental GPA:	(4 point scale)
Current Rank:	Senior Junior Sophomore Freshman
Expected Date of Graduation:
Educational History:	List the colleges and/or universities from which you have completed at least 10 credits. For each organization please upload an unofficial transcript or a PDF statement of your STEM courses that you took and the grade. Also, indicate if there is anything else you want us to know about your GPA. 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.
	High School/ College/University Credits GPA (4 pt scale) Transcript File Upload File Upload File Upload File Upload
GPA Note:	Is anything else you want us to know about your GPA. For example, "My GPA suffered when I had to take online classes during COVID but my recent GPA is above a 3.0."
Educational Goals:	Bachelors 2nd Bachelors Masters Doctorate Post Doctoral
After completing your studies, where do you plan to work? Higher Education Faculty Private Industry Teaching (K-12) NASA Non-NASA Federal Agency State/Local Government Nonprofit Organization Military Consulting Undecided Other
Are you currently a member of any STEM related student organization such as WV SPOT, S.P.A.C.E, AIAA, etc? Yes    No    If yes, please list the organizations.

An endorsement and evaluation by your research advisor is required in support of your application. List the name, title, email and phone number of your research advisor. Once you have submitted your application, we will email the instructions for submitting an on-line endorsement and evaluation on your behalf. Please inform your research advisor that they will be receiving an email from notices@spacegrant.net with these instructions. Your endorsement and evaluation is due by close of business on Tuesday, September 26, 2023.

Name:
Title:
Phone:
email:

Project Title:
Project Description:	Please upload a summary of the research project that you will be conducting. This description should include but is not limited to a description of the research, whether it is a new or continuing project, and significance and/or uniqueness of the research, and budget. The amount awarded varies for each institution. Please contact your institution's representative to inquire about the amount of these fellowships. If you are not a WVU applicant and the anticipated budget exceeds $3,000, please include a budget. If the research is a team project, applicants must clearly indicate the tasks to be completed by each team member(s) and list their work percentage on the project. Submissions should be no more than two (2) single-spaced pages in font size 12, one inch margins and Times New Roman font. The deadline for submission is Monday, September 25, 2023. Upload File: File Upload (PDF Format)
Type of Project:	Individual Team
NASA Alignment:	To which NASA Mission Directorate is your research project most aligned? The full list of NASA Mission Directorates and Center Alignment can be found here. Aeronautics Research Mission Directorate (ARMD) Human Exploration & Operations Mission Directorate (HEOMD) Science Mission Directorate (SMD) Space Technology Mission Directorate (STMD)
NASA Budget Request:
Endorsement:	My Research Advisor, as specified above, has read and endorsed this research project description and has agreed to advise me as I conduct this work.

Resume:	File Upload (PDF Format)
	Have you previously received funding from West Virginia Space Grant Consortium?  Yes   No   If yes, please provide your final report here in PDF format. File Upload

	(for reporting purposes only)
Gender:	Male Female Non-binary
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
Person With Disability:	Yes No    Please specify:
Birthdate:

	I am a citizen of the United States of America.
	I am or will be a full-time undergraduate student during the period of the award.
	If awarded, I agree to provide West Virginia Space Grant Consortium: (1) an end-of-year report detailing my activities and accomplishments during the period of the Fellowship, including publications, research, and meetings attended; and (2) information about my studies and/or employment on request beyond the term of the award. This is part of a NASA requirement to track the long range effectiveness of the scholarship program.
	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.