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  • Applicant Contact and Demographic Form

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  • Optional Information Note: The information below is being requested to help CT Space Grant Consortium Comply with NASA reporting requirements. Thank you for aiding us in the collection of this data. 

  • To answer 'Yes', the applicant must have a physical or mental impairment that substantially limits one or more major life activities and have a record of this impairment. 

  • Should be Empty: