CITY SHAPER (2019-2020 school year) FIRST LEGO League ORTOP Team Support Award Application

General Team Information

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* 1. Name of person completing this application

First Name

Last Name

Email Address

Phone Number

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* 2. Select all the box(es) which describe the role(s) of the person completing this application. (check all that apply)

Teacher

Parent of Team Member

Coach or Mentor of the team

Non-parent Volunteer for the team

School Administrator

School or School District Grant Writer

Other (please specify)

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* 3. Team Location Information

School/Organization (if applicable)

School District (if applicable)

City/Town

State

ZIP/Postal Code

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* 4. Team County Location Information

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* 5. What best describes your team’s affiliation?

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* 6. Please provide the percentage of students at your school who receive free or reduced lunch.

OR

If your team members do not attend public school, please provide the free and reduced lunch percentage for the public school most of the team are zoned to attend. Use the Oregon Department of Education report

Name of Referenced School

Percent of Free and Reduced Lunch at Referenced School

Name of Referenced District

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* 7. ORTOP Team Support Award Compliance Statement. If awarded an ORTOP Team Support Award, applicant/coach must: 1) Complete, sign and return the Award Acceptance Letter with named coaches within 10 days of notification. 2) Maintain records of expenditures, including receipts, for three years after the award date and may be asked to submit documentation to ORTOP in the event of an audit if a check is provided 3) Complete a year-end report and/or questionnaire about student participation and program impacts.
Failure to comply may result in loss of eligibility for future awards through ORTOP.

Yes, I understand and agree to the conditions of the ORTOP Compliance Statement

No, I cannot agree to these statements and withdraw my application for ORTOP Team Support Award funding.

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* 8. Every team must have 2 adult leaders. Please provide contact information for your adult leaders. If unknown at the time of application, please list as unknown.

Lead Mentor #1 First Name

Lead Mentor #1 Last Name

Lead Mentor #1 Email

Lead Mentor #2 First Name

Lead Mentor #2 Last Name

Lead Mentor #2 Email

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* 9. What is your plan for inviting and engaging additional mentors and experts beyond the 2 required mentors? Please describe your successes and challenges in securing mentors and experts.

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* 10. Building STEM literacy and confidence is required to be successful in nearly every endeavor in today’s technology-rich society. Successful companies strive for a diverse workforce to create an innovative and productive workforce, and the ability to collaborate with individuals with different backgrounds and perspectives is a critical workforce skill. An inclusive FIRST team ensures all people are, and feel, free to bring their full selves, offer their true and unguarded perspectives, and find a welcoming and inviting place for those ideas every day.

ORTOP is committed to bringing FIRST to students who would benefit most, and is actively engaged in developing strategies that reduce inequities and ensure greater access to the programs for underserved, underrepresented, and vulnerable youth. Explain the strategies your team uses throughout the season to create an inclusive environment. Focus on how you will apply these strategies in a way that is specific to your team and the opportunities available to you. Describe how the adult mentors on your team are prepared to implement these strategies. Discuss specific challenges your community faces and how you plan to address them. For more information, definitions and suggested strategies, see the materials on the application information page, or go to https://www.firstinspires.org/about/diversityinclusion.

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* 11. Does your team have exclusive access to a LEGO MINDSTORMS robot kit they can use for this season? There should be ONE robot per team, teams should not share a robot during the season.

Yes - there is a LEGO MINDSTORMS EV3 for this team (most common)

Yes - there is a LEGO MINDSTORMS NXT for this team

No, our team does not have access to any LEGO MINDSTORMS robot kit

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* 12. Which best describes your team's meeting scenario?

A for credit class that meets during the day with no after-school meeting time

A for credit class that meets during the day with additional after-school meeting time

Meets only as an after-school club at a school

Meets only as an after-school club at a location other than a school

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* 13. Please describe student interest at this time in having a FIRST team? How many students have committed to be on the FIRST team if you can secure the funds to have one? What are the plans for sustaining membership on the team?

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* 14. How many teams will be registered at your organization/school for the CITY SHAPER FIRST LEGO League season?
Please put how many you hope to register if all your fundraising efforts are successful, even if not all of the teams are applying for ORTOP support.
To apply for ORTOP support EACH TEAM must individually complete this application!

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* 15. For this application is the team whom you are applying for a returning team or a new team. A new team is defined as a team at a new location with new coaches both of which have not had a team in the previous 5 years, or as an additional team to a location with all existing teams returning. A returning team is a location or coach that has had a FIRST LEGO League team number in the past 5 years, even if all of the kids are new.

This application is for a returning team

This application is for a new team