STELLAR:NASA Oklahoma Space Grant Consortium’s

Year-long Mentorship for Pre-service Educators

A. GENERAL INFORMATION

Full Name: _______________________________________________________________________________

Your University: ___________________________________________________________________________

Student Number: ___________________________________________________________________________

Birthdate: ______________________________________________ Male _____ OR Female ______

Mailing Address: __________________________________________________________ (Street Address)

________________________________________________________ (City, State Zip)

Home Phone Number: ____________________________ Cell Number: _____________________________

Email Addresses

Personal: ______________________________ University: _________________________________

Cumulative GPA: ________ (must be 2.9 or higher to qualify for this program)

Classification/Status for 2020-2021 Academic Year (circle one):

Sophomore Junior Senior (eligible ONLY if NOT graduating/student teaching before Fall 2021)

Month and Year of your Expected Graduation: _____________________________

Major (MUST be in elementary, secondary, early childhood, or special education field): __________________

B. SIGNED EDUCATION STATEMENTS

I certify that I am either an UNDERGRADUATE elementary, secondary, early childhood, or special education pre-service education major.

____________________________________________________________ (Applicant Signature and Date)

I certify that I will be classified as a Sophomore or Junior or Senior throughout the 2020-2021 Academic Year. If I will be classified as a Senior, I will not be graduating nor student teaching before Fall 2021.

____________________________________________________________ (Applicant Signature and Date)

I certify that I plan on teaching students in grades K-12 upon completion of my degree.

____________________________________________________________ (Applicant Signature and Date)

D. RACE (circle all that apply)

Black or African American Asian White American Indian or Alaska Native

Native Hawaiian or other Pacific Islander Hispanic or Latino I do not wish to report

E. CITIZENSHIP (required- must be a U.S. citizen to apply)

United States Citizen (circle one): Yes No

F. ESSAY

Write a 200 word or less essay on a separate sheet of paper (one-inch margins; 12-point Times New Roman font) which answers the following questions:

What aspect intrigues you the most about this year-long mentorship? Why? How would this aspect be an asset to your professional development as an educator and to your future classroom? Please be specific!

G. References

List two references. Both references should be familiar with your performance either in the University classroom and/or with students in either formal (public school, private school, etc.) or informal settings (Boy Scouts, Girl Scouts, etc.). One of the two references must be a professor.

REFERENCE #1

Name: ________________________________________________________________________________

E-mail address: __________________________________ Phone: __________________________

REFERENCE #2

Name: ________________________________________________________________________________

E-mail address: __________________________________ Phone: __________________________

The application process involves:

1. E-mailing this completed application (including your essay) as an attachment to our Education Coordinator, Dorinda Risenhoover (education@oknasa.org), no later than 12noon on December 5th, 2019.

2. Beginning the week of December 10th, 2019, all applicants who returned the completed application by the due date will be contacted to schedule a phone interview with Dorinda Risenhoover. In addition, your references will be contacted during this time.

3. By 5PM on Friday, January 3rd, 2020, all applicants will be contacted as to whether or not they received one of the ten available slots for participation in the NASA OKSG STELLAR Class of 2020-2021.

All COMPLETED applications will be considered on a competitive basis based on this completed application, reference checks, and your phone interview. If you should have any questions or need further information, please contact Dorinda Risenhoover, NASA OKSG Education Coordinator, via phone (405-314-9161) or e-mail (education@oknasa.org).