EPP Graduate Sciences Program Student Application

OMB Control #0648-0568
Expires: 10-31-2010

NOAA OFFICE OF EDUCATION
EDUCATIONAL PARTNERSHIP PROGRAM
GRADUATE SCIENCES PROGRAM
STUDENT APPLICATION
STUDENT DATA (please type or use black ink)
Name
(First)
Current Academic Status: [
[
[
[
[

(Middle)
]
]
]
]
]

(Last)

Undergraduate Student
Graduate Student
Baccalaureate Recipient Not Currently Enrolled
M.S. Recipient Not Currently Enrolled
Other

COLLEGE/UNIVERSITY
Department
City

Major
State

Zip

Phone

State

Zip

Phone

SCHOOL RESIDENCE
City
E-mail Address

Cell Phone

Address effective through:
After this date, all correspondence will be sent to the permanent
address listed below unless otherwise requested.
PERMANENT ADDRESS
City

State

Zip

Phone

Fax Number:
GENERAL
How did you learn about the Graduate Sciences Program?
[ ]
Academic Advisor
[ ]
Email communication
[ ]
Scholarship Alumni (please provide name):_________________________
[ ]
Website (please specify): ___________________________________________
[ ]
Advertisement (please specify):______________________________________
[ ]
National Conference (please specify):______________________________
[ ]
Other (please specify):________________________________________________________
PAPERWORK REDUCTION ACT INFORMATION
NOAA Office of Education administers the Educational Partnership Program, Graduate Sciences Program in order to promote the education and
training of students in NOAA sciences. The information contained in this reference form will be used in conjunction with the application to
select graduate students. The information on this form will not be treated confidentially. Public reporting burden for this collection of
information is estimated to average 8 hours per application including the time for reviewing the instructions and completing and reviewing the
collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing the burden, to NOAA Office of Education, Educational Partnership Program, 1315 East-West Highway, Silver Spring,
MD 20910. As needed, student information may be disclosed to the National Oceanic and Atmospheric Administration Office of Civil Rights
and the Workforce Management Office to assist the Office of Education in completing and maintaining the student tracker records. The
justification for sharing information on a need to know basis within the agency is provided explicitly within the statutory language of the Privacy
Act. See 5 U.S.C. 552a(b)(1).
Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to
comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of information
displays a currently valid OMB Control Number.

NOAA OEd EPP/MSI GSP STUDENT APPLICATION

NAME:

U.S. Citizen: [ ] Yes [ ] No
Do you claim veteran’s preference? [ ] Yes [ ] No If yes, mark your claim of 5 or 10 points below:
[ ] 5 points - attach your DD214 or other proof.

[ ] 10 points - attach an application for 10-Point Veteran
Preference (SF-15) and proof required.
Were you ever a Federal Civilian Employee? [ ] Yes [ ] No
If yes, list highest civilian grade given
Series, grade/date

Are you eligible for reinstatement based on career or career-conditional Federal Status?
[ ] Yes [ ] No If yes, attach SF-50 proof
DEGREE PROGRAM
I plan to pursue a [ ] Master's or [ ] Doctorate (check both boxes if a candidate for both degrees)
M.S. degree expected (date)

Major:

Ph.D. degree expected (date)

Major:

NOTE: Support is available for two years (See page 2 of Program Description for additional information).

EDUCATION
List Technical Schools, Universities/Colleges. Begin with most current institution. Transcripts are
required from each institution listed below.

Undergraduate Institutions
INSTITUTION

DATES
ATTENDED

MAJOR

DEGREE
RECEIVED

MONTH/YEAR

GPA

Graduate Institutions
INSTITUTION

DATES
ATTENDED

MAJOR

2

DEGREE
RECEIVED

MONTH/
YEAR

GPA

NOAA OEd EPP/MSI GSP STUDENT APPLICATION

NAME:

RESEARCH EXPERIENCE
Describe paid or non-paid research experience related to NOAA’s mission related sciences.
Position Title

From

To

Hours Per Week

Employer’s Name and Address

Supervisor’s Name and Phone Number

Describe Your Duties and Responsibilities in the space below or on an attached sheet.

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NOAA OEd EPP/MSI GSP STUDENT APPLICATION

NAME:

TWO PAGE ESSAY (Minimum two pages)
Include a two-page essay describing your interest in NOAA and how your graduate education will
support NOAA’s mission. Identify the office in NOAA that would benefit most from your
scientific/research experience.

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NOAA OEd EPP/MSI GSP STUDENT APPLICATION

TWO PAGE ESSAY (continued)

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NAME:

NOAA OEd EPP/MSI GSP STUDENT APPLICATION

NAME:

EMPLOYMENT RECORD
Begin with current or most recent employment (use extra page, if necessary)
EMPLOYER

FROM/TO

POSITION

NATURE OF WORK

ACADEMIC AWARDS AND HONORS
Include undergraduate and graduate honors (if applicable).

EXTRACURRICULAR ACTIVITIES
Include technical societies and service organizations (include offices held).

REFERENCES
List three persons familiar with your academic preparation and your technical capabilities. Please have
these individuals transmit the attached reference form directly to NOAA (address on bottom of reference
form).
1.
2.
3.

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NOAA OEd EPP/MSI GSP STUDENT APPLICATION

NAME:

CURRENT AND PLANNED COURSES
CURRENT COURSES FOR THIS ACADEMIC YEAR
University
COURSE TITLE

COURSE NUMBER

HOURS

PLANNED COURSES FOR THE NEXT ACADEMIC YEAR
If you are not currently enrolled in graduate school, it may be necessary to contact your first choice
university to obtain the required first year courses. Please type or print clearly.
University
COURSE TITLE

COURSE NUMBER

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HOURS

NOAA OEd EPP/MSI GSP STUDENT APPLICATION

NAME:

STATEMENT OF CAREER AND ACADEMIC GOALS AND OBJECTIVES
Please answer the following questions to indicate the relationship between your academic interests and
the objectives of the Graduate Sciences Program. The program is designed to support students interested
in NOAA mission related sciences. Your statements should reflect your interest in these areas. For more
information on NOAA, visit http://www.noaa.gov.
YOUR ANSWERS ARE VITAL TO THE OVERALL EVALUATION OF YOUR APPLICATION.
Use additional sheets as necessary.
1.

Discuss the research area you plan to pursue in graduate school and its relationship to NOAA’s
mission.

2.

Discuss any previous work and/or educational experience in the atmospheric, oceanic, and/or
environmental sciences.

3.

Discuss your career plans as they relate to NOAA’s mission.

My signature acknowledges that I am aware that this program is supported by funding from the United States Government, and
therefore is subject to Federal law regarding false statements and fraud, particularly the criminal provisions of 18 U.S. code
Section 1001. I certify, under the penalty of law, that to the best of my knowledge and belief, all of the information on and
attached to this application is true, correct, complete and made in good faith. I understand that false or fraudulent information on
or attached to this application may be grounds for not hiring me or for firing me after I begin work, and may be punishable by
fine or imprisonment. I understand that any information I give may be investigated.

Signature__________________________________________________________________Date_______
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