Scholarship Grant Application

Scholarship Grant

Please indicate your role in this application
*

I am the a student at a Consortium Affiliated College or University applying for a Grant I am the advisor for the student applicant I am the Campus Director at my institution

Scholarship Application
Please check the type of scholarship desired *

Community College Undergraduate (4 year University/College) Community College Transfer (enrolled in a 4 year university/college after completing education at a community college)
Your Name *

First Name Middle Initial Last Name
Enrollment Status *

Undergraduate Graduate
Official School Email: *
Consortium Member Institution: *
Campus Director Email: *
Major: *
Current GPA *
Expected Year of Graduation/Program Completion: *
Previous Space Grant Awards (Please list all, include title and date): *
U.S. Citizen *

Yes
Academic Advisor: *
Advisor Email: *
Mailing Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Upload Your Narrative: *

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Upload Images (Optional):

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Upload Your Resume: *

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Upload a Copy of Your Student Transcript Here: *

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Upload Letter of Recommendation

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Faculty who wish to submit confidential letters of recommendation can submit them separately (please visit website). Cancel of
Other (Optional):

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Advisor Approval
Applicant Name *

First Name Last Name
Please sign below to verify that you aware of this student's NASA CT Space Grant Consortium Scholarship Application.
Advisor Signature *

First Name Last Name
Date *

Month Day Year
Date

Grant Verification Form
Applicant's Name: *

First Name Last Name
Consortium Member Institution: *
Do you approve of this application? *

Yes No
Reason(Optional)
Eligibility Certification *

I certify that the applicant indicated above either is currently enrolled as a full-time student or is faculty and meets the eligibility requirements, as outlined in the CT Space Grant Student or Faculty Application Booklet and as summarized below
U.S. Citizenship *

U.S. Citizenship is a requirement of eligibility for all CT Space Grant College Consortium awards. Award recipients must provide proof of U.S. Citizenship in the form of one of the following (photocopy is acceptable): U.S. Passport (expired or unexpired); Citizenship Certificate; Naturalization Certificate; Birth Certificate; Military or Company ID Card that Shows Citizenship; or Certified Letter from some other organization that has verified citizenship. By checking this box, the applicant and the Space Grant Campus Director confirm that the student is a U.S. citizen and proof has been provided.

Student Applicant
Vertification: *

I certify that all of the information contained in this application is complete and correct and that I am a US citizen and I meet all of the eligibility requirements for this form.
Applicant Signature: *

First Name Last Name
Date *

Month Day Year

Campus Director:
Campus Directors should check with OSP/Grant Office for any special requirement of each institution that is not included or required by NASA or CTSGC office.
Campus Director is from a 4-year institution? *

Yes
Campus Director Signature: *

First Name Last Name
Date *

Month Day Year

Scholarship Grant