Internship Application
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
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Internship Application
Your Name
*
Mr.
Mrs.
Ms.
Mx.
Prefix
First Name
Middle Initial
Last Name
Enrollment Status
*
Undergraduate
Graduate
Official School Email:
*
example@example.com
Consortium Member Institution:
*
Central Connecticut State University
Eastern Connecticut State University
Fairfield University
Southern Connecticut State University
Trinity College
University of Bridgeport
University of Connecticut
University of New Haven
University of Hartford
Wesleyan University
Yale University
Asnuntuck Community College
Capital Community College
Housatonic Community College
Manchester Community College
Middlesex Community College
Naugatuck Valley Community College
Northwestern Connecticut Community College
Norwalk Community College
Quinebaug Valley Community College
Tunxis Community College
Three Rivers Community College
Campus Director Email:
*
Major:
*
Cumulative GPA:
*
Expected Year of Graduation/Program Completion:
*
Academic Advisor:
*
Advisor Email:
*
U.S. Citizen
*
Yes
No
Previous Space Grant Awards (Please list all, include title and date):
*
Upload Your Narrative:
*
Browse Files
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Upload Your Resume:
*
Browse Files
Please note: There is a one page maximum on Resumes.
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Upload a Copy of Your Student Transcript Here:
*
Browse Files
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Upload Letter of Recommendation:
Browse Files
Faculty who wish to submit confidential letters of recommendation can submit them separately (please visit website).
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Other (Optional):
Browse Files
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Projects:
Please indicate the project or company name you would like to join/apply.
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Grant Verification Form
Applicant Name:
*
First Name
Last Name
Consortium Member Institution:
*
Central Connecticut State Univeristy
Eastern Connecticut State University
Fairfield University
Southern Connecticut State University
Trinity College
Universtiy of Bridgeport
University of Connecticut
University of New Haven
University of Hartford
Wesleyan University
Yale University
Asnuntuck Community College
Capital Community College
Housatonic Community College
Manchester Community College
Middlesex Community College
Naugatuck Valley Community College
Northwestern Connecticut Community College
Norwalk Community College
Quinebaug Valley Community College
Tunxis Community College
Do you Approve of this application?
*
Yes
No
Comment(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 Campus Director confirm that the student is a U.S. citizen and proof has been provided.
By signing below, I certify all information is true and correct to the best of my
knowledge.
Student Applicant
Applicant Signature:
*
First Name
Last Name
Eligibility Certification:
*
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.
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Advisor:
Advisor Signature:
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Campus Director:
Campus Director Signature:
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
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