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 GrantI am the advisor for the student applicantI am the Campus Director at my institution

Scholarship Application
Please check the type of scholarship desired*

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

First NameMiddle InitialLast Name
Enrollment Status*

UndergraduateGraduate
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

CityState / Province

Postal / Zip CodeCountry
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). Cancelof
Other (Optional):

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Advisor Approval
Applicant Name*

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

First NameLast Name
Date*

MonthDayYear
Date

Grant Verification Form
Applicant's Name:*

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

YesNo
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 NameLast Name
Date*

MonthDayYear

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 NameLast Name
Date*

MonthDayYear

Scholarship Grant