Vienna Space Internship Program Application Form 2024

Apply for the Vienna Space Internship Program
Name

First NameLast Name
Preferred Name
Date of Birth

MonthDayYear
Heading
Gender

MaleFemaleNon-binaryPrefer not to sayOther
Student Number
Student Email Address
example@example.com
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mobile Phone
Why do you want to experience the Vienna Space Internship Program?
Please list any academic (or relevant non-academic) prizes, scholarships, or other achievements you have received
Emergency contact details
Full Name

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone
Email Address
example@example.com
Personal and/or medical circumstances
Are there any circumstances which may prevent you from successfully undertaking your internship (for example criminal conviction, academic disqualification, medical condition or injury)? You must declare these matters. This information will be treated as strictly confidential, and will be made known to Placement Provider only after consultation with you.

YesNo
If you have ticked 'yes', please provide details.
Please note Flinders University will not refer a student to a Vienna Space Internship placement position if the University considers that the student may place the Placement Provider at risk, act against the interests of the Placement Provider, or undermine the ongoing goodwill on which the Program rests.
Referees

Please supply the details of a referee (not family members). Your referee may be contacted and asked to supply a verbal referee statement. Please inform your referee that we may make contact with them during the application process, and ensure the contact details you provide are accurate.
Referee Information
Name

First NameLast Name
Your connection to the person
Title
Company
Phone
Email Address
example@example.com
Please share a few supporting documents with us.
Your resume/CV

Cancelof
Your academic transcript

Cancelof
Responsibilities of Students
- Student will have completed or are currently enrolled in the pre-requisite topic, INNO 3007, Outer Space Governance: Business, Policy, Law and Crime. (Please email topic coordinator if not)
To the best of my knowledge, all information that I have provided on this form, is true and correct. I have read the Responsibilities of Students Statement and agree to the general and specific obligations and conditions outlined in that Statement. If any liability shall arise to the Flinders University of South Australia as a result of my providing false or misleading information, I agree to indemnify the Flinders University for any such liability.
Your signature

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Apply for the Vienna Space Internship Program

Heading

Emergency contact details

Personal and/or medical circumstances

Referees

Referee Information

Please share a few supporting documents with us.

Responsibilities of Students