NASA - ESMD Space Grant Internship Application

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NASA Exploration Systems Mission Directorate
(NASA-ESMD) Space Grant Internship Program
2007 Applicant Information Form
Deadline: November 15, 2006 (For Spring Internships)
February 16, 2007 (For All Other Internships)

Internship Eligibility
z

z
z

z
z
z

Must be U.S. Citizen to participate. Proof of citizenship will be
required if selected.
Age 18 or older
Community college, undergraduate and graduate students are
eligible to apply
Minimum of 30 credit hours/45 quarter hours completed
Minimum GPA of 3.0/4.0
Enrolled full-time in an accredited U.S. university, college, or
community college.

Note: You may save your application and for subsequent data entry you will be provided a reentry
pass code. When you have completed the application, print a copy and follow the remaining
procedures listed at the end of the application for final submission. All fields are required except
where indicated.

I. General Data
First Name:
Middle Initial (Optional):
Last Name:
Social Security Number:

(last four digits only)

Email:
Confirm Email:
Birth Date:
Gender:

(mm/dd/yyyy)
Male
Female

Cell Phone:
Emergency Contact Name:
Emergency Contact Phone:
U.S. Citizen:

Yes

No

Current Address:
Address 1:

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Address 2 (Optional):
City:
State:
Zip Code:

-

Telephone:
Current Address Valid Until:

Jan

2006

OR

Indefinitely

Permanent Address:
Address 1:
Address 2 (Optional):
City:
State:
Zip Code:

-

Telephone:
Current Academic Level:

Community College

Full Name of Institution:
Public/Private:

Public

Undergraduate

Graduate

Private

City:
State:
Have you earned credits at any other colleges or
universities?
Specify:

No

Yes

Note: If you answered yes, transcripts must be provided from each institution as part of your
application package for consideration
Status as of January 2007:

Sophomore
Junior

Senior

Graduate

As of January 2007, how many total credit hours will you have earned?
Are you a full time student?

Yes

No
semester hours
quarter hours

Anticipated graduation date:
Cumulative GPA:
Explain, if other:

Jan

2006
/ on a scale of

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(3.0 or 4.0 or other)

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Current academic major or demonstrated coursework concentration in engineering, mathematics,
computer science or physical/life sciences is a requirement.
Major(s):
Engineering
Aerospace/Aeronautical/Astronautical
Chemical
Civil/Environmental Health
Electrical/Electronic/Computer
Engineering Physics
Industrial/Manufacturing
Materials/Metallurgical
Mechanical/Engineering Mechanics
Nuclear
Other, please specify:
Physical Sciences
Astronomy/Astrophysics
Chemistry
Optics
Physics
Other, please specify:
Earth/Atmospheric/Ocean Sciences
Atmospheric Sciences
Geography
Geosciences
Natural Resource Management
Oceanography
Other, please specify:
Mathematics/Computer Science
Mathematics/Applied Mathematics
Computer Science
Other, please specify:
Biological Sciences
Astrobiology
Biology
Biochemistry/Biophysics
Microbiology/Bacteriology
Other, please specify:
Other Major not listed:

Minor(s):

Engineering

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Aerospace/Aeronautical/Astronautical
Chemical
Civil/Environmental Health
Electrical/Electronic/Computer
Engineering Physics
Industrial/Manufacturing
Materials/Metallurgical
Mechanical/Engineering Mechanics
Nuclear
Other, please specify:
Physical Sciences
Astronomy/Astrophysics
Chemistry
Optics
Physics
Other, please specify:
Earth/Atmospheric/Ocean Sciences
Atmospheric Sciences
Geography
Geosciences
Natural Resource Management
Oceanography
Other, please specify:
Mathematics/Computer Science
Mathematics/Applied Mathematics
Computer Science
Other, please specify:
Biological Sciences
Astrobiology
Biology
Biochemistry/Biophysics
Microbiology/Bacteriology
Other, please specify:
Other Minor not listed:

Current Degree Seeking:

B.S./B.A.

Joint B.S./M.S.

M.S.

Ph.D.

Explain, if other:

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Date Expected:

Jan

2004

II. NASA ESMD Space Grant Internship Opportunities
Select no more than three (3) codes to indicate which internship position(s) you are applying
for. If you select more than three codes, your application will be ineligible and you will not be
considered for any internship positions. For description of these codes and other constraints
associated with these internship opportunities, please refer to: http://www.vsgc.odu.edu/esmd
ARC1-00107AN
ARC2-00207AN
ARC1-00307AN
ARC1-00407AN
ARC1-00507AN
ARC1-00607AN
To select multiple codes, select the first code, and then hold
down the CONTROL key while clicking on any other code.
Timeframe of availability for the
Internship

To
(mm/dd/yyyy)

(mm/dd/yyyy)

III. Additional Information
Describe any related activities that demonstrate your interest/commitment to your chosen discipline.
(e.g., memberships in related organizations, hobbies, special skills, honors, awards). Please list and
describe your previous participation in any NASA sponsored programs (e.g., internships, research
programs, scholarships/fellowships, job shadowing, workshops).
Please limit your description to not more than 2000 words

Describe any other experiences you think would enhance your application. (e.g., internships, camps,
workshops, relevant work history).
Please limit your description to not more than 2000 words

What do you hope to gain from participating in the NASA–ESMD Space Grant Internship Program
and how might the research experience help you in your chosen discipline/future career?
Please limit your description to not more than 2000 words

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List your relevant coursework that would enhance your research experience.
Please limit your description to not more than 2000 words

List computer hardware and software capability:
Please limit your description to not more than 2000 words

Where did you hear about the NASA-ESMD Space Grant Internship Program?
Please limit your description to not more than 2000 words

IV. Certification
When the application is complete and ready for transmission, please print a copy before submitting it.
A signed copy of this certification is required (see below).
I certify that I am a citizen of the United States and that all information contained in this NASA-ESMD
Space Grant Internship Program application package is accurate.
____________________________________
Signature

___________________________
Date

Application Requirements
1) Electronic submission of application form is required.
2) One complete copy of the entire application package must be mailed to:
Virginia Space Grant Consortium

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Attention: ESMD Coordinator
Old Dominion University Peninsula Center
600 Butler Farm Road, Suite 200
Hampton, VA 23666
The following items MUST be included in your application package:
*One printed copy of the application you submitted on-line, including the certification section.
*One copy each of two letters of reference on letterhead
One must be from a faculty member; the second may be from a faculty member or employer.
Letters can be unsealed or sealed. and appropriate copies made; or if your reference wishes
the recommendation can be sealed.
*One copy of official or unofficial school transcript listing grades through fall semester of Summer
2006 for spring positions. Include transcripts from each college or university attended. An official
transcript will be required prior to final placement.
No late applications or partial packages will be accepted. No faxed materials will be accepted (no
exceptions).
APPLICATIONS MUST BE RECEIVED BY NOVEMBER 15, 2006 (FOR SPRING INTERNSHIPS)
AND FEBRUARY 16, 2007 (FOR ALL OTHER INTERNSHIPS). A courier service with return receipt
option should be used to mail your application package.
We will not be able to accept queries regarding the status of individual applications. You will be
notified if you are selected. We anticipate completion of selections and notification of all applicants by
December 2006 for Spring internships, and April 2007 for summer and fall internships.

Use the save feature when subsequent data entry is required prior to submission.
Note: You will not be able to make changes in the document once it has been submitted; however,
you will be able to access the application for printing.

Save for later submission

Final submission

Continue

http://platinum.ts.odu.edu/esmd2007.nsf/application?OpenForm

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