ESA Academy Short Course Scholarship – Student application form Short Course – Student Application form Student information Name * Name First name First name Last name Last name Email * Age * Students should be aged minimum 18 years old. Gender * Male Female Other/ Not Applicable Nationality * AustriaBelgiumCanadaCzech RepublicDenmarkEstoniaFinlandFranceGermanyGreeceHungaryIrelandItalyLatviaLithuaniaLuxembourgNetherlandsNorwayPolandPortugalRomaniaSlovakiaSloveniaSpainSwedenSwitzerlandUnited Kingdom Only students from ESA Member States, Associate States, or Canada are eligible. Current level of study * BachelorMasterPhDOther Current level of study Field of study * ScienceEngineeringLegalBusinessOther (please add more information in the comment box) Field of study University name * University country * Is this course embedded in your academic programme? * Yes No Have you ever been sponsored by ESA? * Yes No Have you ever received an ESA Academy sponsorship or scholarship to participate to a conference or course, or have you ever participated to an ESA Academy activity (training, project, experiment, campaign, etc.)? Which activity/ies or programme did you participate to? * Do you have more than 2 years of professional experience? * Yes No Last or current employer * Scholarship request Motivation to attend the course: * 0 of 100 max words Expectations from participating in the course: * 0 of 100 max words Justification for ESA Academy scholarship request: * 0 of 100 max words Do you benefit from an overlapping financial support to attend this course? * Yes No An overlapping financial support is any other financial support that will cover or partially cover your registration fee, travel, or accomodation. Please describe the other financial support: * Do you agree with the with ESA Academy’s Privacy Policy. * No Yes Submit If you are human, leave this field blank.