NASA Marshall Space Flight Center
Application Deadline: 1 February 2010
I. General Data
Last Name:
Middle Initial (Optional):
First Name:
Primary Email Account:
U.S. Citizenship:
(Citizenship is required.) / ___Yes ____No
Gender: / ____Male ____Female
Race (Optional): / ¨ American Indian or Alaska Native
¨ Black or African American ¨ Asian
¨ Native Hawaiian or Pacific Islander ¨White
¨ Other Race
Ethnicity (Optional): / ¨ Hispanic or Latino ¨ Other
Disability (Optional): / ¨ Hearing Impairment ¨ Visual Impairment
¨ Mobility/Orthopedic Impairment ¨ Mental Impairment
¨ None ¨ Other (specify)
Current Address: /
Address 1:
Address 2:
City:
State:
Zip Code:
Mobile Phone:
Current Address Valid Until:
Permanent Address: /
Address 1:
Address 2:
City:
State:
Zip Code:
Primary Telephone Number:
II. Academic Data /
Name of Academic Institution:
City:
State:
Zip Code:
Current Academic Standing:
(e.g., jr., sr., graduate student)
Anticipated Graduation Date:
Cumulative GPA:
Credits Completed:
Academic Major, Minor, or Areas of Concentration:
Major(s):
Minor(s):
Areas of Concentration:
Degree Pursuing:
III. Research Experience
Which other NASA programs or events have you previously participated? (e.g., INSPIRE, SEMAA, Space Camp, Moonbuggy, SLI, USLI, internship at another NASA Center)
List any work experience that could enhance your participation in this internship. (e.g., workshops, camps, relevant work history, project/team work).
List your computer hardware and software capabilities, and laboratory skills.
IV. Additional Information
List any honors, awards, certifications, special skills, memberships in professional organizations, presentations, publications, offices held, and aerospace activities.Describe other interests, experiences, hobbies
What do you hope to gain from this experience?
V. Certification
I certify that I am a citizen of the United States and that all information contained in this application is accurate.
Signature / Date
Supporting Documents: / Resume, Transcript, Letters of Recommendation
Email completed application and resume to:
Mail official transcript (required) and letters of recommendation (encouraged, but not required) to:
Mona Miller
NASA Marshall Space Flight Center
HS30 / Academic Affairs Office
Marshall Space Flight Center, AL 35812