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 :

Race :
Black/African American
Native American
Pacific Islander
White Caucasian

Are you a person with disability ?

Yes No
Education level :

If graduate level, please name undergraduate institution :

Please list all other sources of financial support
including Duration and Amounts :

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 :

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 * :