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The INSPIRE Project, Inc.
107 S West Street
PMB #425
Alexandria, VA 22314-2824

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SPACE ACADEMY FOR STUDENTS SCHOLARSHIP APPLICATION
Please complete all required fields for the 2017 Space Academy for Students Scholarship Application.
STUDENT INFORMATION
First Name*
Middle Name*
Last Name*
Address*
Apartment Number/Unit number
City*
State*
Zip Code*
GenderMale   Female   *
Date of Birth (xx-xx-xxxx)*
Race*
Do you have any disabilities?*
If yes, please describe
Age (as of August 2017)*
Grade entering in the Fall?*
Name of school attending in Fall*
T-Shirt Size (Adult)*
PARENT/GUARDIAN INFORMATION
Primary Parent Name (for correspondence)*
Relationship to Student?*
Daytime Phone*
Home Phone
Parent Cell Phone
Primary Phone (in case of emergency)*
Parent Email (for all correspondence)
STUDENT ESSAY
Please submit your child's essay "Why I want to go to Space Camp" (250-500 words)
File Upload (PLEASE INCLUDE YOUR NAME IN THE DOCUMENT NAME - Example: JohnSmithSpaceCampEssay2013.pdf) Please submit your essay as a .pdf (preferred), .doc or .docx    
Please print this form for your records before submitting.
Validation Code
*
 


The INSPIRE Project, Inc.
is a NASA educational portfolio program