CT SPACE GRANT COLLEGE CONSORTIUM
Out-of-State/ Non-CT Cover Sheet
Industrial Internship: Summer 2015 for National Students
(Non-CT Consortium Member Institutions)
Application to be submitted by Friday, April 3, 2015
The information provided in this form will be used to match students with potential internship
employers associated with the CT Space Grant Program. Participating companies will receive
copies of this information.
Completed student application will consist of:
1. Industrial Internship Application Cover Sheet
2. Abstract
3. Resume/Curriculum Vitae
4. One Letter of Recommendation
5. Student Transcript
6. Grant Verification Form
7. Application Contact/Demographic Information
Special Notes:
 Proof of U.S. Citizenship – This and other pre-employment screening paperwork will be
required of all students selected to participate in the internship. As government
contractors, many of these employers may have their own varying levels of pre-employment
badging requirements, which may include, but are not limited to, pre-employment drug
testing and background investigations. Selected applicants will be made of aware of the
specific requirements upon receiving an offer of internship placement.
 Support from Applicant’s State Space Grant Consortium – Evidence of your state’s Space
Grant Consortium agreement that if you are selected for participating in this 10-week
summer internship, that your state’s Consortium will award you an internship
fellowship/travel grant to pay 1) the suggested stipend (suggested at $6,000) for the 10week internship assignment, and 2) cover your travel to and from Connecticut.
CT SPACE GRANT COLLEGE CONSORTIUM
203 Dana Hall, University of Hartford (Lead Institution)
200 Bloomfield Avenue, West Hartford, CT 06117
860-768-4813 [email protected] www.ctspacegrant.org
Primary Investigator (PI)
Name: ☐ Mr. ☐ Ms. ☐ Mrs.
State Space Grant Consortium
School
Major
Academic Advisor
Advisor Email
Previous Space Grant Awards
(Please list all; include title/date)
Citizenship: ☐ US Citizen
Year of Expected Graduation:
State’s Space Grant Consortium Director
Director’s Email & Phone
☐ I am at least 18 years old and a US Citizen.
☐ My state’s Space Grant Consortium supports my application and will fund my
participation ($6,000 stipend recommended + travel expenses) if I am selected.
_______________________________________________
Applicant Signature
______________________
Date
_______________________________________________
State’s Space Grant Director Signature
______________________
Date
Please Indicate Companies you are interested in (Check all that apply)
☐ UT Research Center
☐ UTC Aerospace Systems
☐ Sikorsky Aircraft
(Hamilton Sundstrand)
☐ UTC Power
☐ Pratt & Whitney Aircraft
☐ Carrier
☐ OTIS
☐ Connecticut Invention Convention
☐ Dymotek Corp.
☐ Connecticut Corsair
☐ Doncasters Group
☐ CCAT
☐ Other_____________________________________________________________________
(Please list all)
CT SPACE GRANT COLLEGE CONSORTIUM
203 Dana Hall, University of Hartford (Lead Institution)
200 Bloomfield Avenue, West Hartford, CT 06117
860-768-4813 [email protected] www.ctspacegrant.org
Please consider the following questions when writing your abstract:
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Please list all technical courses you have taken that may be helpful to hiring managers in
considering your qualifications.
Why are you interested in working within a UTC division or another Connecticut
company this summer?
Why should you be selected for this position?
Describe how your technical interests/experience will be enhanced by this internship.
How will this internship enhance or contribute to your long-term academic and career
goals?
What has been the extent of your contact with UTC or other Connecticut company?
(Please indicate the name of any individuals you have been working/speaking with.)
Institutional Certification
☐
Signatures below certify that the applicant’s institution approves of this application and
acknowledges an understanding that if this proposal is awarded, the institution will need
to enter into a sub-contract between itself and the University of Hartford before any
NASA CT Space Grant Consortium funds can be disbursed.
___________________________________________
Campus Director Signature
_________________________
Date
____________________________________________
Advisor Signature
_______________________
Date
CT SPACE GRANT COLLEGE CONSORTIUM
203 Dana Hall, University of Hartford (Lead Institution)
200 Bloomfield Avenue, West Hartford, CT 06117
860-768-4813 [email protected] www.ctspacegrant.org