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Center for Lunar Science and Exploration

2024 Field Training and Research Program
at Meteor Crater

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Application Form

Form closes on June 10, 2024 at 11:59 p.m., U.S. Central Daylight Time, GMT-5

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Denotes required field

Contact Information

First Name

Middle Name

Last Name

Primary Email

Confirm Primary Email

School Email

Primary Phone

Secondary Phone

Permanent Address

Street 1

Street 2

City

State / Province / Region

Zip / Postal Code

Country

Address During the School Semester

Is your address during the school semester the same as your permanent address?

Street 1

Street 2

City

State / Province / Region

Zip / Postal Code

Country

Scholastic Information

School / University Presently Attending

Degree Program

Grade Point Average

(4.0 = A, 3.0 = B)

Current Major

Are you currently enrolled in a M.S. or Ph.D. program?

Biographical Information

Please provide a brief description of your (a) relevant experience, (b) thesis topic (if determined), (c) impact cratering processes and planetary surfaces, and (d) how you think this field geology program will enhance your educational goals in planetary science and exploration.

PDF format only. 10MB maximum file size.

Do not upload any documents that contain sensitive Personally Identifiable Information (PII) such as social security number, date of birth or school identification numbers.

Upload Bio

Upload your CV in PDF format.

PDF format only. 10MB maximum file size.

Do not upload any documents that contain sensitive Personally Identifiable Information (PII) such as social security number, date of birth or school identification numbers.

Upload CV

English Reference

Is English your native language?

Letters of Recommendation

Two (2) letters of recommendation are required and must be submitted electronically by the application deadline. Recommenders must submit their letters in English using the online form. Letters sent by email or after the application deadline will not be accepted. Please provide the names and email addresses of the individuals who will be submitting letters of recommendation.

	Full Name	Email Address
1.
2.

Citizenship ¹

Are you a U.S. Citizen?

Are you a naturalized U.S. Citizen?

Date of naturalization

Birth Country

Birth Province

Birth City

1st Citizenship

Are you a Lawful Permanent Resident of the U.S.?

Resident Since (mm/dd/yyyy)

Are you Currently in the U.S.?

What is your current immigration status?

Other Immigration status

Have you ever been on a J-1 short-term scholar status before?

Date Status ended

Do you have a current, pending application for another status?

What Status?

Do you have dual citizenship?

2nd Citizenship

Demographics Information

USRA is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, USRA invites internship applicants to self-identify their gender, race, and ethnicity. Submission of this information is voluntary, and refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential and will only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.

As government contractors, USRA also complies with government regulations, including but not limited to, affirmative action responsibilities as required under Executive Order 11246, Section 503 of the Rehabilitation Act of 1973, section 4212 of the Vietnam Veterans Readjustment Act of 1974, and Veterans Employment Opportunities Act (VEOA) of 1998.

Gender

Preferred Pronouns

Date of Birth (mm/dd/yyyy)

Race / Ethnicity

Are you Hispanic or Latino?

Select one or more of the following races:

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Other Race

U.S. Veteran Status

Not a veteran

Armed forces service medal veteran

Disabled veteran

Recently separated veteran

Other veteran

Disability Status:

Do you have a qualifying disability that is protected under the American Disabilities Act or the Rehabilitation Act of 1973?

I certify that I have removed all sensitive Personally Identifiable Information (PII) such as Social Security Number, date of birth or school identification numbers from documents submitted with this application.

I certify that the information provided on this application is complete and accurate. I understand that any false statements or omissions may be considered grounds for termination of my application and/or internship.

¹ Due to security issues, citizens of U.S. State Department Designated Countries are not eligible. Reference the Designated Country List at this website: https://www.nasa.gov/oiir/export-control.

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2024 Field Training and Research Program
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