Sylvia Stein Memorial Space Grant Scholarship
Application Form

Application Deadline: April 3, 2006
Notification: May 12, 2006

You may download or print this application and complete it for submission. 



Name:

Penn State ID Number:

Local address:

Local phone number:
Email:
Status (e.g. sophomore 4th semester):
Major/College:
Current GPA:
Home/summer address:
 

Home/summer phone:
 

I certify that (initial each):
[Note: If any statement is not initialed, your application will not be considered.]
___ I am a citizen of the United States.
___ I am or will be a full-time undergraduate student during the academic years 2006-2007.
___ If awarded the Sylvia Stein Scholarship, I agree to provide PSGC information about my studies and/or employment on request beyond the term of the award. (This is part of a NASA requirement to track the long range effectiveness of the scholarship program.)

Signature_______________________________________ Date___________

 

Would you like to subscribe to our announcement list to receive updates on opportunities?   yes  no 


The following questions are requested solely for statistical purposes. Provision of this information is optional.

Please indicate your predominant ethnic background:

Native American (Indian)___     Alaskan Native___      White American (not Hispanic)___
Puerto Rican___   Hispanic American (not Puerto Rican)___
Pacific Islander (specify)___________ African American (not Hispanic)___
Asian American ___Other (specify) ________________
Student with disability(specify)_________________________

Gender:  Male____   Female_____
Student with disability(specify)_________________________


Please submit an original and two copies of the application materials in the following order:
  1. Application form
  2. Letter of recommendation by department or program head
  3. Letter of recommendation from a faculty member or an advisor
  4. Two-page essay of proposed plan of study, proposed career plans, life goals, and how career plans are related to any aspect of NASA's strategic enterprises
  5. Resume including extra-curricular activities, work experience, or community service, evidence of good mentoring skills, awards or scholarships, and local phone number  and  address
  6. A brief description of interest in and ideas for mentoring or education outreach activities.
  7. SAT scores;   College transcripts


Please submit your application to:
Jeanine Emigh
The Pennsylvania Space Grant Consortium
Penn State University
2217 Earth-Engineering Sciences Building 
University Park, PA  16802
814-865-2535
Go to the Pennsylvania Space Grant Consortium Home Page
Go to The Pennsylvania State University Home Page