PR NASA Space Grant

Fellowship Application 2017-2018

Cover Page
PERSONAL INFORMATION
Name:

Mailing Address:

Phone Numbers

e-mail:

Birth Date: Gender:

Citizenship:

PROGRAM INFORMATION

Academic program you will be in August 2017: ______________________________________

Institution and Campus you will be in August 2017: ___________________________________

Academic Level you will be in August 2017: ____ BS/BE _____ MS _____ PhD

PREVIOUS FELLOWSHIPS & PROGRAMS

NSF-EPSCoR PR NASA PR-BRIN/INBRE
AGEP Fellowship MARC/RISE GK-12
AGEP Mentoring AMP/BD Fellowship Other Fellowships

Send this application form, official transcript, statement of professional

goals, research proposal, and two letters of recommendation to:

Ms. Mildred Rodrguez, Project Manager

NASA PR Space Grant
PO Box 23334
San Juan, PR 00931

or by email: mildred.rodriguez@upr.edu

For information, call: 787-282-7047 or 787-765-5170, ext 2117

Application Deadline is Friday, June 23, 2017