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Fellowship/Graduate Assistantship
Fellowship/Graduate Assistantship Application
Part 1
Required fields are indicated by *
Last name
*
:
First name
*
:
Address :
City :
State :
Zip :
Email address
*
:
Phone number
*
:
Additional Contact phone number :
For statistical information only
Date of Birth :
Gender :
Female
Male
Race :
Black/African American
Latino
Native American
Pacific Islander
White Caucasian
Other
Are you a person with disability ?
Yes
No
Education level :
Undergraduate
Graduate
If graduate level, please name undergraduate institution :
Please list all other sources of financial support
including Duration and Amounts :
Source: Duration: Amount: Source: Duration: Amount: Source: Duration: Amount:
How much funding per semester are you requesting ?
When do you need funding and for how many semesters ?
Current GPA (Official transcript required for verification) :
Major and Minor :
Advisor :
Target Degree :
Anticipated graduation date :
Three reference letters
are required within one month of submission of your application. At least one reference must be (academic) from a teacher and/or professor (if you are a grad student). All references can be emailed to
gsgc@gatech.edu
Please submit the following information for your 3 references :
Name: Title: Place of Employment: Name: Title: Place of Employment: Name: Title: Place of Employment:
How did you find out about the Georgia Space Grant Consortium Fellowship Program?
I agree to participate in longitudinal tracking surveys (for NASA and the Georgia Space Grant Consortium); acknowledge the Georgia Space Grant (as appropriate); and agree to inclusion in public information (newsletters, website).
Initials
*
:
Date
*
: