Internship Grant Application

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

Internship Application
Your Name *

Prefix First Name Middle Initial Last Name
Enrollment Status *

Undergraduate Graduate
Official School Email: *
example@example.com
Consortium Member Institution: *
Please enter the email address for your institution's Campus Director. If you are not sure who your Campus Director is, please click here or visit the link below to see our full list of contacts.

http://ctspacegrant.org/wp-content/uploads/2020/01/Campus-Directors-and-OSP-Info-PDF-1.pdf
Campus Director Email: *
Major: *
Cumulative GPA: *
Previous Space Grant Awards (Please list all, include title and date):
U.S. Citizen *

Yes
Expected Year of Graduation/Program Completion: *
Academic Advisor: *
Advisor Email: *
Upload Your Narrative: *

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Upload Your Resume: *

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Please note: There is a one page maximum on Resumes. Cancel of
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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Grant Verification Form
Applicant's Name: *

First Name Last Name
Consortium Member Institution: *
*

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
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.
Applicant Signature: *

First Name Last Name
Date *

Month Day Year
Date

Internship Application