TASP Coop Application Form

NOTE: All fields are required! Do not leave blank. Please type N/A if a field does not apply to you.
Personal Information

Last Name	First		Mail Code:

Work Number:	Fax Number:		Bldg./Room#:

E-mail Address:	Supervisor:		Supervisor Phone:

Employer:
Contractor, please state name of company. NASA employees, please state name of your division.

In which week would you like to work?
You may choose from these weeks:
Week 1: June 3-8, 2001 Week 2: June 10-15, 2001 Week 3: June 17-22, 2001 Week 4: June 24-29, 2001		Week 5: July 8-13, 2001 Week 6: July 15-20, 2001 Week 7: July 22-27, 2001 Week 8: July 29-August 3, 2001
Select 3 in order of preference.
First choice:	Second choice:		Third choice:



Education, Interest, and Skills

Degree Type:	Major:
Career Field/Job Title:
Hometown:	Special Skills: Bilingual Skills - Language(s)
Other:

Check any areas for which you have expertise and an interest in assisting the TASP.

Applied Science/Aerospace
Applied Science/Engineering/Computer
Applied Science/Engineering/Electrical
Applied Science/Engineering/Mechanical
Applied Science/Engineering/Mathematics
Earth Science (Geology, Meteorology, Oceanography, Environmental Science, etc.)
Life Science (Biology, Health Sciences, etc.)
Physical Science (Chemistry, Physics, etc.)
Space Science (Astronomy, Planetary Science, etc.)
Other:


Certification of Agreement to the Terms of the TASP
By submitting this application to work as a TASP volunteer, I certify that I:
am voluntarily submitting this application, will abide by the rules and guidelines of the TASP, have obtained my supervisor's approval to participate in this program, and understand that I must obtain my supervisor's approval for any specific periods of time that I am doing TASP volunteer work.
I certify that I have read and fully understand and accept all terms of the foregoing TASP Agreement? Yes No