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NOTE: It is recommended that you collect the necessary data before you begin filling out this form. This Web page will time-out after 90 minutes. You may modify and edit your application up until the deadline for your program. After the deadline, your application will be final. If your application is complete by the deadline, it is automatically submitted to GSA and will be reviewed in full. You do not have to click anything to re-submit. Please verify your contact information *= required Name, Phone and Email :
Middle Initial :
*Last Name :
Email #2 :
Title :
Phone (Evening) :
Cell Phone :
*First Name : *Email : Phone (Day)
*Please enter at least one phone number. GSA Member ID : 5965 Permanent Address Information: University/Com : pany/ Organization
Department :
: *Street/PO Box
: *City :
: *Zip
*State
SELECT
: *Country
SELECT
Current Address Information (only fill out if different than above): : Street/PO Box
: City :
: Zip
State
Address available until:
: Country
SELECT
SELECT
MO
DAY
YEAR
If there is a time period during the application/selection process when you will be unavailable or difficult to reach, please indicate the dates of unavailability, and the best way to contact you. On To The Future *What is the name of your current institution?:
*Please select your institution type: SELECT
*Please select your current education level: SELECT
*What is your expected graduation year?: SELECT
*What is your declared major?: *Social Security Number (no hyphens or spaces). This will only be used for tax purposes if you are selected to receive an OTF award: Have you been selected to participate or awarded funding through another GSA Program(s) in the last 3 years (make all that apply):
GeoCorps
Student Research Grant Recipient
Mosaics in Science
Bighorn Basin Field Award
Field Camp Scholar Award
Subaru Minority Scholarship
I have not participated in another GSA Program *Do you identify yourself as a person with a disability? This information will only be used for statistical purposes, and for the purposes of facilitating placements for persons with disabilities: Yes
No
If ''yes'', please choose from the list below:
Blind or Visually Disability
Deaf or Hearing Disability
Physical or Orthopedic Disability
Learning or Cognitive Disability
Vocal or Speech Disability
Other
I wish no to identify *Are you a first generation college student? This means your parents or anyone in your immediate family has not attended college (undergraduate degree program)?: Yes
No
*Are you a non-traditional student? Non-traditional is defined by the National Center for Education Statistics as a student who ''delayed enrollment in postsecondary education by a year or more after high school or who attended part-time, have family constraints such as dependents other than a spouse, single parent, working-full time, or being financially independent from parents, and students who did not receive a standard high school diploma.'' Yes
No
Application Questions Please provide answers to the following questions. Answers are limited to 1,500 characters, including spaces. If you cut and paste from a document, check that your answer is included in its entirety. To do this, scroll through your full answer. Explain your professional goals and how your attendance to the GSA Annual Meeting will help you reach these goals.
1500
characters left
Describe your financial need and indicate how much you are requesting, including how these funds will be used.
1500
characters left
OTF is a partial travel award program. This means you may have to seek funds outside of OTF to cover your full cost of travel. What is your plan to find additional funds to support your travel to the Annual Meeting?
1500
characters left
Other Information *How did you find out about this program? (Select one option) SELECT
Do you give GSA permission to share your application with other programs within GSA and with other partner organizations outside of GSA? (This would include other field, research, internship, or scholarship programs offered by science organizations, government agencies and other similar groups.)? Yes
No
*Are you currently a U.S. citizen or a U.S. permanent resident ("green card" holder)? (This is a requirement for GeoCorps and Mosaics. It is generally not a requirement for other programs.) Yes
No
*Birth Date
This information is required by the government for statistical purposes, but is NOT used in selection decisions. (However, for Mosaics in Science positions only, candidates must be in the age range of 18 - 35 years old. There is no age limitation on other programs or positions.) Day:
Month:
SELECT
SELECT
Year: SELECT
*Please explain how you can enrich GSA’s goal to support a diverse and inclusive geoscience community. (300 character max.)
*Are you currently, or were you formerly, a member of the U.S. Armed Forces? Yes
No
*Gender? Female
Male
*Ethnicity SELECT
APPLICANT STATEMENT I certify that all information provided in this application is true and complete. This includes information in my education and work history, cover letter(s), grade record, and anything else submitted to GSA for this program. I understand that any false information or omission may disqualify me from further consideration for GSA programs and may result in my dismissal if discovered at a later date. I authorize the investigation of any or all statements contained in this application. I authorize, whether listed or not, any person, school, current employer, past employers, and organizations to provide relevant information and opinions that may be useful in making a selection decision. I release such persons and organizations from any legal liability in making such statements. I have read, understand, and by selecting submit, I consent to these statements. By submitting this application, I agree to receive communications from The Geological Society of America (GSA) which may include electronic newsletters, emails and postal delivery of information about the Society's operations, programs and opportunities. GSA values your privacy and will only use your contact information for the purposes of the Society. GSA follows best practices to ensure the safety, reliability, and privacy of its electronic and postal communications. You have the right to opt-out of these communications at any time. Please see the GSA website for our full privacy policy. If you have questions about your application, please contact Tahlia Bear, [email protected] Next
[LOG OUT]
NOTE: It is recommended that you collect the necessary data before you begin filling out this form. This Web page will time-out after 90 minutes. You may modify and edit your application up until the deadline for your program. After the deadline, your application will be final. If your application is complete by the deadline, it is automatically submitted to GSA and will be reviewed in full. You do not have to click anything to re-submit. Please verify your contact information *= required Name, Phone and Email :
Middle Initial :
*Last Name :
Email #2 :
Title :
Phone (Evening) :
Cell Phone :
*First Name : *Email : Phone (Day)
*Please enter at least one phone number. GSA Member ID : 5965 Permanent Address Information: University/Com : pany/ Organization
Department :
: *Street/PO Box
: *City :
: *Zip
*State
SELECT
: *Country
SELECT
Current Address Information (only fill out if different than above): : Street/PO Box
: City :
: Zip
State
Address available until:
: Country
SELECT
SELECT
MO
DAY
YEAR
If there is a time period during the application/selection process when you will be unavailable or difficult to reach, please indicate the dates of unavailability, and the best way to contact you. On To The Future *What is the name of your current institution?:
*Please select your institution type: SELECT
*Please select your current education level: SELECT
*What is your expected graduation year?: SELECT
*What is your declared major?: *Social Security Number (no hyphens or spaces). This will only be used for tax purposes if you are selected to receive an OTF award: Have you been selected to participate or awarded funding through another GSA Program(s) in the last 3 years (make all that apply):
GeoCorps
Student Research Grant Recipient
Mosaics in Science
Bighorn Basin Field Award
Field Camp Scholar Award
Subaru Minority Scholarship
I have not participated in another GSA Program *Do you identify yourself as a person with a disability? This information will only be used for statistical purposes, and for the purposes of facilitating placements for persons with disabilities: Yes
No
If ''yes'', please choose from the list below:
Blind or Visually Disability
Deaf or Hearing Disability
Physical or Orthopedic Disability
Learning or Cognitive Disability
Vocal or Speech Disability
Other
I wish no to identify *Are you a first generation college student? This means your parents or anyone in your immediate family has not attended college (undergraduate degree program)?: Yes
No
*Are you a non-traditional student? Non-traditional is defined by the National Center for Education Statistics as a student who ''delayed enrollment in postsecondary education by a year or more after high school or who attended part-time, have family constraints such as dependents other than a spouse, single parent, working-full time, or being financially independent from parents, and students who did not receive a standard high school diploma.'' Yes
No
Application Questions Please provide answers to the following questions. Answers are limited to 1,500 characters, including spaces. If you cut and paste from a document, check that your answer is included in its entirety. To do this, scroll through your full answer. Explain your professional goals and how your attendance to the GSA Annual Meeting will help you reach these goals.
1500
characters left
Describe your financial need and indicate how much you are requesting, including how these funds will be used.
1500
characters left
OTF is a partial travel award program. This means you may have to seek funds outside of OTF to cover your full cost of travel. What is your plan to find additional funds to support your travel to the Annual Meeting?
1500
characters left
Other Information *How did you find out about this program? (Select one option) SELECT
Do you give GSA permission to share your application with other programs within GSA and with other partner organizations outside of GSA? (This would include other field, research, internship, or scholarship programs offered by science organizations, government agencies and other similar groups.)? Yes
No
*Are you currently a U.S. citizen or a U.S. permanent resident ("green card" holder)? (This is a requirement for GeoCorps and Mosaics. It is generally not a requirement for other programs.) Yes
No
*Birth Date
This information is required by the government for statistical purposes, but is NOT used in selection decisions. (However, for Mosaics in Science positions only, candidates must be in the age range of 18 - 35 years old. There is no age limitation on other programs or positions.) Day:
Month:
SELECT
SELECT
Year: SELECT
*Please explain how you can enrich GSA’s goal to support a diverse and inclusive geoscience community. (300 character max.)
*Are you currently, or were you formerly, a member of the U.S. Armed Forces? Yes
No
*Gender? Female
Male
*Ethnicity SELECT
APPLICANT STATEMENT I certify that all information provided in this application is true and complete. This includes information in my education and work history, cover letter(s), grade record, and anything else submitted to GSA for this program. I understand that any false information or omission may disqualify me from further consideration for GSA programs and may result in my dismissal if discovered at a later date. I authorize the investigation of any or all statements contained in this application. I authorize, whether listed or not, any person, school, current employer, past employers, and organizations to provide relevant information and opinions that may be useful in making a selection decision. I release such persons and organizations from any legal liability in making such statements. I have read, understand, and by selecting submit, I consent to these statements. By submitting this application, I agree to receive communications from The Geological Society of America (GSA) which may include electronic newsletters, emails and postal delivery of information about the Society's operations, programs and opportunities. GSA values your privacy and will only use your contact information for the purposes of the Society. GSA follows best practices to ensure the safety, reliability, and privacy of its electronic and postal communications. You have the right to opt-out of these communications at any time. Please see the GSA website for our full privacy policy. If you have questions about your application, please contact Tahlia Bear, [email protected] Next
