MDABESTRobotics Grant application HEA kits.pdf

MDA BEST Robotics Grant: HEA Kits Application 2017

Completed forms should be saved and submitted as FullUniversityName_MDABESTRoboticsGrant_Kits_2017. If there is any confusion, please refer to the actual grant for clarification.

1. Hub Information

a. DUNS Number:

b. Name: c. Physical Site/University Name:

d. Mailing Address:

City: State: ZIP Code:

2. Hub Director Information

a. Name:

b. Title or Position: c. Phone:

d. University or Organization: e. E-mail Address:

f. Mailing Address:

City: State: ZIP Code:

3. Hub’s Increase Potential

Please briefly describe your hub’s potential (workforce pipeline growth) for increasing STEM interest with middle and high school students if funding support is provided.

4. Hub’s Service Region Information and Statistics

Please enter the all the service regions and states that the hub supports along with the population statistics about each, up to 10. If your hub services less than 10 counties, you will not use all the space provided. The American Fact Finder website by the United

States Census Bureau is a helpful resource (http://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml).

a. County: b. State:

c. AVG Income: d. % at Poverty Status:

e. % 9th -12th but No Diploma: f. % High School Diploma/GED: g. % Bachelor’s Degree:

h. Top Three Business Industries:

a. County: b. State:

c. AVG Income: d. % at Poverty Status:

e. % 9th -12th but No Diploma: f. % High School Diploma/GED: g. % Bachelor’s Degree:

h. Top Three Business Industries:

a. County: b. State:

c. AVG Income: d. % at Poverty Status:

e. % 9th -12th but No Diploma: f. % High School Diploma/GED: g. % Bachelor’s Degree:

h. Top Three Business Industries:

a. County: b. State:

c. AVG Income: d. % at Poverty Status:

e. % 9th -12th but No Diploma: f. % High School Diploma/GED: g. % Bachelor’s Degree:

h. Top Three Business Industries:

Approved for Public Release 17-MDA-9114 (29 March 17) http://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml

a. County: b. State:

c. AVG Income: d. % at Poverty Status:

e. % 9th -12th but No Diploma: f. % High School Diploma/GED: g. % Bachelor’s Degree:

h. Top Three Business Industries:

a. County: b. State:

c. AVG Income: d. % at Poverty Status:

e. % 9th -12th but No Diploma: f. % High School Diploma/GED: g. % Bachelor’s Degree:

h. Top Three Business Industries:

a. County: b. State:

c. AVG Income: d. % at Poverty Status:

e. % 9th -12th but No Diploma: f. % High School Diploma/GED: g. % Bachelor’s Degree:

h. Top Three Business Industries:

a. County: b. State:

c. AVG Income: d. % at Poverty Status:

e. % 9th -12th but No Diploma: f. % High School Diploma/GED: g. % Bachelor’s Degree:

h. Top Three Business Industries:

a. County: b. State:

c. AVG Income: d. % at Poverty Status:

e. % 9th -12th but No Diploma: f. % High School Diploma/GED: g. % Bachelor’s Degree:

h. Top Three Business Industries:

a. County: b. State:

c. AVG Income: d. % at Poverty Status:

e. % 9th -12th but No Diploma: f. % High School Diploma/GED: g. % Bachelor’s Degree:

h. Top Three Business Industries:

5. Competition Year 2016 Participant Information

Please enter number totals for the hub, and not for individual service regions.

a. Students: b. Adults/Teachers: c. Teams:

d. Elementary Schools: e. Middle Schools: f. High Schools:

6. Projected Competition 2017 Information

a. Total Number of Teams:

b. Number of New Kits Needed: c. Requested Funding Amount:

Approved for Public Release

Attachments

When saving and submitting your attachments, please use the names listed below. Your attachments should be labeled with the appropriate attachment name and submitted with your application.

Attachment Name Description Submitted on Grants.gov

7. Proposed Schedule of Events A proposed schedule of events for the upcoming competition 2017 season

YES ☐

NO ☐

8. Support Letter 1 A signed support letter on official letterhead from the physical site’s senior leadership (internal), such as the University President or Vice-President, to increase the number of teams

YES ☐

NO ☐

9. Support Letter 2 A signed support letter on official letterhead from BEST Robotics National Headquarters (external) for increasing the number of teams hosted by the local hub

YES ☐

NO ☐

10. Optional Support Letter:

Local Government 1, 2, or 3

OPTIONAL: Signed support letters on official letterhead from local and/or state government (limit 3)

YES ☐

NO ☐

11. Optional Support Letter:

STEM professional 1, 2, 3, 4, or 5

OPTIONAL: Signed support letters on official letterhead from STEM professional or technical non-profit societies or organizations (limit 5)

YES ☐

NO ☐

12. Optional Support Letter:

Local Industry 1, 2, 3, 4, or 5

OPTIONAL: Signed support letters on official letterhead from local (within hub service region) industry (limit 5)

YES ☐

NO ☐

13. Post-Award Agreement

A signed acknowledgement and agreement on official letterhead from the Hub Director to provide MDA STEM outreach with required post-award reporting, including but not limited to, demographic information, information briefs, videos, and/or photographs

YES ☐

NO ☐

14. SAM certification A certification that SAM information is current

YES ☐

NO ☐

15. WAWF certification A certification that a WAWF account is current

YES ☐

NO ☐

Approved for Public Release