Astronaut Trail Shell Club Scholarship Application Form
Section I.
Applicant’s Name: _________________________________________________
Applicant’s Mailing Address:________________________________________
________________________________________________________________
________________________________________________________________
 Degree sought: ___________________________________________________

Name of College or University: ______________________________________
_______________________________________________________________

Name of Major Professor:___________________________________________

Title: ___________________________________________________________

Section II.
A. Title or Thesis – Research:__________________________________________
__________________________________________________________________
 B. Attach a brief description of research.
C. Attach a brief description of how the scholarship will assist the research.
D .Signature of Applicant: _______________________________________________
E. Date: _____________________________________________________________
Section III.
I certify that  ______________________________________ (name of applicant) is a regularly

enrolled graduate or post graduate student at (name of college or university) ________________
_____________________________________________________________________
in the __________________________ Department.

The above is, to the best of my knowledge, a true representation of his/her research.
Signature of Major Professor:_____________________________ Date__________


Submit completed application to:
ASTRONAUT TRAIL SHELL CLUB
Scholarship Committee
F. Matthew Blaine , Chairman
908 West Street,
Laurel, Delaware
19956-1932
*Application must be received by 5:00 PM EST, October 14 at the above address.
*Applications and all related material must be received in hard copy to the above address. No e- mail, fax, or electronic transmissions accepted for the actual application.
*Please include a SASE if you would like to be notified of the winner/ winners.



                                                                        Revised: July, 2012

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