2021-22 Vermont Space Grant Consortium (VtSGC)
Scholarship Program

Deadline for applying March 1, 2021

Full Name:*

First Name Middle Name Last Name

E-mail Address: (personal)*

Address

Street Address

Street Address Line 2

City State

Postal / Zip Code

Home Phone Number:

Cell Phone Number:

Area Code Phone Number

Are you a U.S. Citizen? (Citizenship required.)*

Yes No

Educational Information: What Vermont College/University do you expect to be attending in August 2021? If you are chosen to receive this scholarship, you must attend an accredited college/university located in Vermont, in order to receive the scholarship.
(Make selection from drop box below.)

Attending University/College:*

Major*

Overall GPA*

Minimum 3.0/4.0 GPA

Current Status*

Univ/College Graduation:*

Month

Year*

Year

Transcript Submission*

Unofficial copy will suffice. PDF file is preferred. If graduating senior, must be from last marking period in THIS school year.

Provide a detail of your career goals and their direct relevance to the United States' aerospace industry and the goals of NASA. (Add comments regarding academic research project involvement, if any, including project, advisor's name and employer.)*

0/250

Employment Goals: What type of employment will you seek after graduation? Will you pursue a career with NASA? (250 words or less.)*

0/250

Comments: (In 250 words or less, tell us why you would be a good candidate for a scholarship or fellowship, or other comments on your eligibility. Include curricular activiites, honors & societies.)*

0/250

Have you previously received a Space Grant award?

Yes No

If so, please provide a brief overview of the ways in which Vermont Space Grant scholarship funding has been beneficial to the pursuit of career goals and/or employment, and your increased awareness of NASA and its mission. (250 words or less.)

Please provide me with the name of the individual(s) (a maximum of two) that will be completing your letter(s) of recommendations.

Recommendation Letter: Submission of at least one recommendation letter is required (maximum of two) by a mentor or academic advisor. It is the responsibility of the applicant to ensure that the individual submitting the letter do so by the March 1st @ 4:00 p.m. application deadline. Send an e-mail to your mentor/advisor to use the following URL for an online submission: https://form.jotform.com/203375363215148

It is strongly recommended that your mentor or academic advisor speak to how you personally meet the criteria of this scholarship.

Please complete the following to self-report demographics for NASA data collection and reporting systems. This information will not impact selection of awardees, and will not be released to the selection committee.

Demographics: Gender

Male Female

U.S. Military Service

Yes No

Ethnicity:

Hispanic or Latino Not Hispanic or Latino I prefer not to answer

Race (mark one or more of the following):

Do you have a documented disability?

Yes No I prefer not to answer

AGREEMENTS AND DECLARATIONS: Check the boxes below each question as appropriate.

I meet all of the eligibility requirements as outlined in the program announcement.*

Yes No

If selected, I agree to provide final unofficial transcripts upon graduation to the Vermont Space Grant.*

Yes No

If selected, I agree to participate in a NASA longitudinal tracking process which surveys student progress and eventual employment outcome to help assess the effectiveness of the program.*

Yes No

I am the person represented in this application. All of the provided information is complete and correct.*

Yes No