Nasa Scholars Program

NASA SCHOLARS PROGRAM

Ames Research Center

Internship Application

At NASA Ames Research Center, our goal is to place all summer interns in work experience assignments that compliment their discipline and study interest. It is important that you assist us in meeting your needs and interest. Applicants for the NASA Scholars Summer Internship at Ames Research Center are urged to complete this questionnaire and return it to Brenda Collins, Higher Education Officer, NASA Ames Research Center, Mail Stop 226-8, Moffett Field, CA 94035-1000 no later than February 3, 2006.

Please circle the NASA Program in which you are participating:

ACCESS Boeing Diversity Program DCES IMAGE MAES

Minority Access NACME SHPE SPACE USAR

WISE Other__________________________________

Institution:____________________________________________________________________

Program Director: _____________________________________________________________

Program Director’s Phone Number (__________)___________________________________

Program Director’s E-mail Address ______________________________________________

NAME:_________________________________________________________________

(Last, First, Initial)

CURRENT MAILING ADDRESS:

PHONE NUMBER (____________)_________________________________________

E-MAIL_________________________________________________________________

NASA SCHOLARS PROGRAM

Ames Research Center

Internship Application

HIGHEST LEVEL OF EDUCATION COMPLETED:

Freshman Sophomore 1st Semester Jr.

2nd Semester Jr. 1st Semester Sr. 2nd Semester Sr.

Major:______________________________________________________________ (required)

Minor:______________________________________________________________

Cumulative GPA: ______________/ 4.0 (required)

(CURRENT TRANSCRIPT required)

WHAT IS YOUR RESEARCH INTEREST/GOALS AT AMES?

Please be specific. Your work assignment depends on how well you are able to articulate your desired work experience. (200 words minimum essay – attach)

Have you previously participated in an internship program at a NASA center?

If so, please specify the identify the program:______________________________

__________________________________________________________________

When? ___________________ Where? _______________________________

*PLEASE ATTACH RESUME AND RECENT TRANSCRIPT*

NASA SCHOLARS PROGRAM

Ames Research Center

Internship Application

PERMANET HOME ADDRESS:

_____________________________________________________________________________

PHONE: (____________)______________________________________________

In case of an emergency please notify the following person at the address indicated below:

NAME_______________________________________________________________________

ADDRESS:___________________________________________________________________

_____________________________________________________________________________

PHONE: Home (_____________)_____________________________________

Work (______________)_____________________________________

Relationship _________________________________________________________

Please list any special medical condition(s) or accommodations:

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

*PLEASE BRING DOCUMENTATION OF ANY MEDICAL INSURANCE WITH YOU*

Limited health care is provided during working hours for all interns if you are injured on the job, but each intern is responsible for carrying their own medical insurance in the event you require medical attention beyond normal working hours or if our facilities do not meet your medical needs.

NASA SCHOLARS PROGRAM

Ames Research Center

Internship Application

Each student is responsible for his/her food and lodging cost during this summer internship. Please be advised that the San Francisco Bay Area is a “HIGH COST of living area”. NASA Ames Research Center does not provide student housing or financial assistance.

Due to the aforementioned housing cost, we will strive to ASSIST the student in securing affordable housing. Please consider your housing needs and check the option(s) below that apply to you.

I DO NOT REQUIRE ASSISTANCE IN SECURING HOUSING.

I REQUIRE ASSISTANCE IN SECURING HOUSING.

I am interested in living in the Moffett Lodge at Ames ($15.00 per day-double occupancy, $30.00 per day-single).

I am interested in having the Education Office assign a roommate for me (based on information provide by applicants).

Gender: Male Female

I am interested in finding a roommate on my own (contact information of other participants will be made available).

I am interested in living in the Oakwood Inn‘s fully furnished apartments – approximately 1.5 miles away from Ames Research Center. 1-bedroom: $37.50 per day - double occupancy, $75 per day - single. 2-bedroom: $23.75 per day - quadruple occupancy, $31.67 per day – triple occupancy, $47.50 per day – double, $95 per day single).

Please check your room selection and specify your choice of occupancy :______________________________ (Prices may vary)

HOUSING INFORMATION WILL BE SENT TO YOU BASED UPON YOUR RESPONSE TO THE UPON QUESTIONS