Form NASA C-3707 NASA C-3707 Dropping In a Microgravity Environment (DIME)

National
Aeronautics and
Space
Administration

Educational Programs Office
Dropping In a Microgravity Environment (DIME)
Please type or print in black ink only.

Full legal name

Date of birth
Last name, suffix (e.g., Jr.)

First name

mm/dd/year
(e.g., 11/14/1992)

Middle name

Place of birth

Gender
City

U.S. Citizen

Yes

State

Female

Male

Country

No

Note: If U.S. Citizen and born outside the United States or Puerto Rico, you must provide the information requested below. If selected, you must
provide documentation prior to start date for acceptance to be finalized.
Naturalization number

Date issued

Date expired

Passport number

Date issued

Date expired

You must provide both addresses:
Permanent (home) address

School name
If homeschooled, write "homeschooled"

School address
City

State

9-digit Zip Code

Telephone number
City

State

Cell phone number

School telephone number

Permanent e-mail address

School e-mail address

9-digit Zip Code

Academic level this school year:
HS Freshman

HS Sophomore

HS Junior

Have you previously applied for or participated in a NASA program?

HS Senior
Yes

No

Check any of the following NASA programs you have previously applied for (A) or participated in (P) and indicate the year:
(A)

(P)

YEAR

(A)

(P)

YEAR

FIRST

GRC TSU College Bound

GRC Exploring Program

INSPIRE

GRC LERCIP High School

NES (NASA Explorers School)
School Name
SEMAA

GRC N.A.S.A. Project

Site Name
GRC Shadowing Program

Other
OFFICE USE ONLY

Date received
NASA C-3070 (NOV 10)

Date processed

Initials