2016-2017 ORTOP TEAM SUPPORT AWARD APPLICATION for FIRST TECH CHALLENGE

Applicant Contact Information and Demographics

Complete the application for one team in FIRST Tech Challenge after reviewing the ORTOP Team Support information page.
2016-2017 ORTOP Team Support Award is administered by the Oregon Robotics Tournament and Outreach Program and funded by numerous ORTOP sponsors including Intel, Rockwell Collins, Google, Garmin, MJ Murdock Charitable Trust and others.

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* 1. Name of the applicant completing this application

Name:

Email Address:

Phone Number:

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* 2. Check the box(es) that best describe the role(s) of the person completing the application

Teacher

Parent of a team member

Coach or Mentor for the team

Non-parent volunteer for the team

School administrator

School or School District Grant Writer

Other (please specify)

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* 3. Applicant, School or Organization Contact Information

School/Organization (if applicable): *

School District (if applicable): *

Mailing Address: *

Address 2:

City/Town: *

State: *

ZIP: *

COUNTY (not country): *

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* 4. ORTOP Team Support Award recipients are limited to teams in the states of Oregon and Washington (Skamania/Klickatat counties). What best describes your team's affiliation?

Public School

Public Charter School

Private School

directly managed by a non-profit organization as an after-school or weekend program

not affiliated with an organization or school; such as neighborhood team

non-profit organization affiliated club/troop not directly managed by non-profit organization

Homeschool team

Other (please specify)

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* 5. Using the links to demographic information available on the application information page.
Please provide the percentage of students at your school who receive free or reduced lunch. If your team members do not attend public school, please provide the free and reduced lunch percentage for the public school they are zoned to attend.

Name of referenced school/district

Percentage of Free at Reduced Lunch at referenced public school

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* 6. Workers in industry who identify as Black, Latino/Hispanic or Native Americans are currently
underrepresented in jobs requiring high-tech skills and STEM-related college degrees. Please describe your strategy to be inclusive of Black, Latino/Hispanic or Native Americans students on your team as well as any challenges in doing so.

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* 7. For which type of award are you choosing to apply? (Select one per application)

FIRST Tech Challenge - ROOKIE TEAM (7th - 12th Grade)

FIRST Tech Challenge - VETERAN TEAM (7th - 12th Grade)