Student Awardee FY12

1. Name and Projects

 
Please contact the NASA Nebraska Space Grant if you have questions regarding this survey. Phone: 402-554-3772 Email: NASA.Nebraska@unomaha.edu

If you participated in several NASA projects this year, you may receive several notices to complete this survey. Please only complete this form once. Include all your NASA project-related outcomes on this one form. This form will comprise your final report.

This information is for internal reporting to NASA only. While we did collect some of this information at the time of application, NASA has revised the definitions to align with the federal government definitions and categories.
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1. Student Name
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2. Mark all of the NASA-related projects you participated in this year.
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3. Gender
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4. Race
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5. Ethnicity
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6. Disability
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7. Citizenship
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8. Date of Birth (MM/DD/YYYY)
MM DD YYYY
Date of Birth
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9. Current Address
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10. Permanent Address
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11. Email Address
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12. Phone
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13. Status
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14. Additional Status Detail. Please select one of the following to further describe your status.
15. If you marked Graduated in the previous questions, please describe your current status (i.e. which degree program and institution are you now enrolled in, current job and employer, etc.).
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16. Project Activity Dates (mm/dd/yy) (Use best judgment)
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17. Please complete the following information based on the date you received your award this year.
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18. Were you engaged in Research as part of your NASA award this year?
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19. Did your NASA award involve a NASA Center?
20. Indicate if your NASA award involved any of the following.
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21. Provide the following information about your primary Faculty Mentor on your NASA project(s).
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22. How many AUTHORS have PUBLISHED results of research / activities directly attributed to this project? (if none, enter 0)
23. Please provide the following information for each publication. Use one line per publication.
* Author(s)
* Year
* Title of Article
* Type of Publication: Journal, Book, Proceedings, or Other
* Peer-Reviewed (Yes or No)
* Author Category: Faculty, PostDoc, or Student
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24. How many AUTHORS have SUBMITTED manuscripts of research / activities directly attributed to this project, but are not yet published? (if none, enter 0)
25. Please provide the following information for each publication. Use one line per publication.
* Author(s)
* Year
* Title of Article
* Type of Publication: Journal, Book, Proceedings, or Other
* Peer-Reviewed (Yes or No)
* Status: Declined, Pending, Accepted
* Author Category: Faculty, PostDoc, or Student
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26. How many INVITED PAPERS based on research / activities directly attributed to this project were PRESENTED? (if none, enter 0)
27. Please provide the following information for each presentation. Use one line per presentation.
* Title
* Presenter
* Venue
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28. How many SELF-SUBMITTED PAPERS based on research / activities directly attributed to this project were presented at CONFERENCES that use a REVIEW PROCESS? (if none, enter 0)
29. Please provide the following information for each presentation. Use one line per presentation.
* Title
* Presenter
* Venue
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30. How many PROPOSALS were SUBMITTED for additional funding (NASA and external), based on activities associated with this project? (if none, enter 0)
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31. How many PROPOSALS were FUNDED (NASA and external), based on activities associated with this project? (if none, enter 0)
32. Please provide the following information for each FUNDED proposal. Use one line per proposal.
* Proposal Title
* Institution that Submitted Proposal
* Name of Funding Organization
* Type of Funding Organization: NASA, Other Funding Agency, State Agency, Private Foundation, Non-Profit, Industry, or Other
* Amount Requested
* Amount Received
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33. How many PATENTS, based on research / activities associated with this project, have been APPLIED for? (if none, enter 0)
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34. How many PATENTS, based on research/activities associated with this project, have been GRANTED? (if none, enter 0)
35. Please provide the following information for each GRANTED patent. Use one line per patent.
* Patent
* Date Received
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36. How many PATENT LICENSES, based on research /activities associated with this project, have been ISSUED? (if none, enter 0)
37. Please provide the following information for each LICENSE ISSUED. Use one line per license.
* License
* Date Issued
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38. How many TECHNOLOGY TRANSFER activities have resulted from research / activities associated with this project? (if none, enter 0)
39. Please provide the following information for each TECHNOLOGY TRANSFER ACTIVITY. Use one line per activity.
* Activity
* Transfer Partner
40. If you entered information on Patents, etc., have you followed the guidelines regarding reporting requirements found here: http://ne.spacegrant.org/uploads/images/Mini-Grants/inventionguide.pdf
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41. Will you or your siblings be the first in your family to graduate from college?
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42. Did you qualify for subsidized school lunch in any part of K-12?
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43. Describe the results and / or outcomes of your NASA project(s) or experience(s).
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44. Describe how this NASA project or experience enriched your education, and your current or future employment.
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45. Has this experience influenced you to pursue a Science, Technology, Engineering, or Math (STEM) related career or employment, or reaffirmed your decision to pursue a STEM-related career or employment?
46. If no, how have your plans changed as a result of this experience.
47. Use this space to share any problems or difficulties with your NASA project(s) or experience(s).
48. Use this space for any additional comments you wish to share.
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49. Acknowledgment: Through your participation in the NASA project(s) and / or experience(s), you agreed to participate in the required NASA longitudinal tracking. This means that NASA will track you into your next step be it your next degree program or your next employment. Presently the tracking is conducted by the NASA Nebraska Space Grant. However, with the establishment of the new OEPM reporting system, NASA may be requesting this information from you directly in the future. We appreciate your participation as NASA assesses the Nebraska Space Grant program on the response rate of student awardees.

Additionally, information provided in this final report may be used in reports to NASA.
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50. List links to all relevant publicity pieces regarding this project. You can email any relevant publicity documents, images of the project implementation, etc. to NASA.Nebraska@unomaha.edu

In the email, be sure to include your name and project title so we can appropriately cite.
51. Do NOT complete. For Department Use Only.
Add Students to Spreadsheet if Necessary
52. Do NOT complete. For Department Use Only.
Sent for Approval
53. Do NOT complete. For Department Use Only.
Follow-up if Necessary
54. Do NOT complete. For Department Use Only.
Corrections Entered
55. Do NOT complete. For Department Use Only.
Entered into OEPM
56. Do NOT complete. For Department Use Only.
Update Spreadsheet
57. Do NOT complete. For Department Use Only.
Print for Student File