ESA-USGS Cooperative Summer Internship Program Nomination If you have any questions, please contact: email@example.com Nominations for ESA/USGS Cooperative Field Internships Thank you for your support for the ESA-USGS Cooperative Summer Internship Program. We appreciate your taking the time to nominate your student/s. You may nominate up to two students who participated in your field course/program. Both students should have completed the SAME course or program. Your course/program will be added to a directory of field course and programs with your consent and will be a resource to students looking for outstanding field programs. Your Contact Information Prefix Dr. Mr. Mrs. Ms. Miss Mx. First Name * Last Name * Position * Organization/University Address * Organization/University Address Organization/Institution Organization/Institution Department Department City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Email Address * Information about Student Nominee Student First Name * Student Last Name * Student Email Address * Kindly ensure accuracy of email Student Current Class Standing * Freshman Sophomore Junior Senior Student Current Institution * In about 200 words, please describe the reasons for your nomination * Your recommendation is vital for the ESA-USGS cooperative internship. Please include the students' accomplishments, ability to learn or adapt to new situations, strengths in field experience, leadership potential and how this experience might be transformative. Do you have another student to nominate who took the same field course or field program?? * Yes No Student 2 First Name Student 2 Last Name Student 2 Email Address Kindly ensure accuracy of email Student 2 Current Class Standing Freshman Sophomore Junior Senior Student 2 Current Institution In about 200 words, please describe the reasons for your nomination of Student 2 Your recommendation is vital for the ESA-USGS cooperative internship. Please include the students' accomplishments, ability to learn or adapt to new situations, strengths in field experience, leadership potential and how this experience might be transformative. On the next page, you will be asked to submit information about the field course or program your nominee/s completed within the last six months. The information you provide about your field course or program will also allow ESA to list your program in our field directory. Even if you have previously nominated a student and submitted this information, kindly resubmit so we have the most up to date information. Thank you. If you are human, leave this field blank.