SUBMIT COMPLETED APPLICATION TO YOUR HIGH SCHOOL PRINCIPAL OR GUIDANCE COUNSELOR

Application due date October 2, 2000

Texas Aerospace Scholars Program

Student Application

I. STUDENT DATA

Please Print Legibly or Type

_________________________________________________________________________
Name: Last / First / Middle Name / Preferred Name

_________________________________________________________________________
Home Address

_________________________________________________________________________
City / State / Zip Code / Telephone

_________________________________________________________________________
Date of Birth / Student's E-mail Address

U.S. Citizen: Yes ________ No ________ Gender: Male ________ Female ________

Ethnic Group - check or circle one (optional)

African American	Pacific Islander
Hispanic	Caucasian (not Hispanic)
Native American	Asian (not Pacific Islander)
Multiracial/Ethnic	Please Specify___________________

II. PARENTAL CONSENT

I understand that my child is being considered for a position in the Texas Aerospace Scholars Program which will include a 1-week period, Sunday through Friday, at the Johnson Space Center between June and August. Direct supervision will be provided by a NASA sponsor. I certify below, that I

· give permission for my son/daughter to participate in the Texas Aerospace Scholars Program activities;
· approve the release of my child's school transcript;
· approve and authorize medical treatment in case of an emergency; and
· guarantee my child's participation for the full 1-week of the program (in the event he/she cannot fulfill this commitment, I understand that his/her participation will terminate immediately).

Emergency Contact_____________________________________________________

Relationship _____________________Telephone Number ______________________

Parental Signature ____________________________________Date ______________

Parents' Phone Number (if different from above) ________________________________

Texas Aerospace Scholars Program

III. ESSAY FORM

Name: ______________________________________Date: __________________

Prepare a 300-word legibly written or typed essay addressing the following:

· Reasons for wanting to participate in the Texas Aerospace Scholars Program;
· Special talents, hobbies, work experience, volunteer work, honors, awards, commendations and extra curricular activities; and
· Education and career interests and aspirations.

Name of High School_______________________________________________________

Please attach a copy of your transcript to this Student Application Form (If available, transcript should include final grades for courses through the 2000 Spring academic semester.)

Texas Aerospace Scholars Program

IV. TEACHER RECOMMENDATION

TOP PORTION TO BE COMPLETED BY STUDENT BEFORE SUBMITTING TO TEACHER FOR
RECOMMENDATION.

_____________________________________________________________________
Student's Name: Last / First / MI.

Name and Title _________________________________________________________

School/Organization _____________________________________________________

How long have you known the student and in what capacity?______________________

_____________________________________________________________________

Please tell us in narrative form why you endorse this student for the Texas Aerospace Scholars Program.
Address what you know about the student's academic performance and participation in school activities. Attach an additional sheet of paper if necessary.
PLEASE PLACE THIS RECOMMENDATION FORM IN A SEALED ENVELOPE BEFORE RETURNING TO STUDENT.

Signature _____________________________Date ________________

May we contact you for additional information? Yes ___ No ___

Telephone No. ______________________

This form should be returned to the student in a sealed envelope as a part of the student packet.