Academy Registration

DATE PREFERENCE
Please select and mark in order of your preference *
Preference 1 *
- June 28-July 1
- July 12-15
Preference 2 *
- June 28-July 1
- July 12-15
Preference 3 *
- June 28-July 1
- July 12-15
CONTACT INFORMATION
Name **
First Last
Email **
Address **
Phone **
ACADEMIC HISTORY
Academic Year Completed by Jan 2021 **
Current Institution
Location **
Degree **
Major **
Minor **
Additional Information
Why do you want to attend the Space Trek Academy?
Research Experience and Publications (if any)
General Work Experience
Aerospace and Space-Related Activities
Memberships
Other Information
Consent **
I, certify that the information provided on this form is true to the best of my knowledge.

Space Trek academy REGISTRATION FORM