HPP Internship Application Form

OMB Control Number 0648-0568, expires XX/XX/20XX

Hollings Prep Program Internship Application Form
APPLICATION MATERIALS
First and Last Name

Email address

What university do you attend?

What is your academic major?

Please upload your resume and cover letter below.
Resume

Cover Letter

APPLICANT DEMOGRAPHICS
Completion of this section will be appreciated. Submission of this information is
voluntary and will have no effect on the review of your application. The information
collected will be used only for statistical and program management purposes, and will
be stored separately from your application materials during the review process. The
OMB control number for this collection is 0648-0568.
[PRIVACY ACT INFORMATION HERE]
[PURPOSE AND ROUTINE USES HERE]
ETHNICITY
Are you Hispanic or Latino?
❏ Yes
❏ No
❏ Decline to answer
RACE
❏ Black or African American
❏ White
❏ Asian
❏ American Indian or Alaska Native
❏ Native Hawaiian or Pacific Islander
❏ Other
❏ Decline to answer

Gender:
○ Female
○ Male
○ Other
○ Decline to answer

Date of Birth:
Month▽

Day▽

Year▽

Public Burden Statement
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a
penalty for failure to comply with an information collection subject to the requirements of the Paperwork Reduction Act of
1995 unless the information collection has a currently valid OMB Control Number. The approved OMB Control Number for
this information collection is 0648-0568. Without this approval, we could not conduct this information collection. Public
reporting for this information collection is estimated to be approximately 1 hour per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
information collection. All responses to this information collection are required to obtain benefits. Send comments regarding
this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to the
NOAA Office of Education, Natasha White, [email protected].
Privacy Act Statement
Authority: The collection of this information is authorized under 5 U.S.C. 301, Departmental Regulations and 15 U.S.C. 1512,
Powers and duties of Department.
Purpose: NOAA’s Office of Education proposes to collect contact information and associated background information of
undergraduate and graduate students, as well as recent graduates, for the purpose of tracking scholarship recipients’
academic progress, making annual financial awards, and tracking graduate studies and career progress. Demographic
information will be used to measure the success of stated Diversity, Equity, Inclusion, and Justice (DEIJ) goals only. This
information will not be used to determine program eligibility.
NOAA Routine Uses: NOAA will use this information to evaluate and assess student data and information for the purpose of
selecting successful candidates for scholarships, fellowships and internships, generating internal NOAA reports, and articles
to demonstrate the success of its program.
Disclosure of this information is permitted under the Privacy Act of 1974 (5 U.S.C. Section 552a) to be shared among NOAA
staff for work-related purposes. Disclosure of this information is also subject to all of the published routine uses as identified
in the Privacy Act System of Records Notice Commerce/NOAA-14, Office of Education, Educational Partnership Program
(EPP); Ernest F. Hollings Undergraduate Scholarship Program and National Marine Fisheries Service Recruitment, Training,
and Research Program.
Obligation to Respond: Furnishing this information is voluntary; however, failure to provide information may prevent
consideration of your application for the program.