Precollege Mini-Grant Program Form

							   NASA Office of Education Performance Measurement (OEPM)
                System - Precollege Program Form

Project Information

Name of Project:
Contact Person:
Address:


City:
State:
ZIP Code:                                 Contact Phone + Area Code:      (   )

Location of Project Activities: (Mark all that apply)

         NASA Center(s)
         University Campus(es)
         Elementary/Middle/High School
         Community Facilities
         Museum/Planetarium(s)
         Industry or Private sector Facilities
         Other

Project Status: (Choose Project Status)

         Developing
         Newly Implemented
         Continuing
         Ending

End Date of Project: (Format Example: 24-Sep-2000)

Descriptive Information
Please provide a brief description of the project: (limited to 1,900 characters – approx. 30 lines)
OEPM – Precollege Program Form                                                                    2

 Please provide a brief description of the project: (limited to 1,900 characters – approx. 30 lines)




     Are Evaluation mechanisms in place?


Describe Evaluation Methodology: (limited to 1,900 characters - approx 30 lines)
OEPM – Precollege Program Form                                                           3

Choose most closely related discipline (Choices available are as follows):

Aeronautical/Aerospace, Agricultural, Anthropology, Architectural, Architecture, Art,
Astronomy, Astrophysics, Atmospheric Science, Biochemistry, Bioengineering, Biology,
Botany, Chemical, Chemistry, Civil, Climatology/Meteorology, Computer, Computer Science,
Earth Sciences, Economics, Education, Electrical/Electronic, Engineering, Engineering
Mechanics, Engineering Science, Environmental, Environmental Sciences, Geography, Geology,
Geophysics, Health Science/Nutrition, History, Industrial, Life Sciences, Materials
Science/Engineering, Mathematics, Mechanical, Medicine/Medical Research, Mining/Petroleum
& Natural Gas, Molecular/Cell Biology, Nuclear, Oceanography, Other, Philosophy, Physical
Sciences, Planetary GeoSciences, Planetary Sciences, Political Science/Public Policy,
Psychology, Social Sciences, Sociology, Zoology)




If not listed above, enter name of discipline:



Funding and Collaboration Information
Actual Sources of Funding for this reporting period (include cash or noncash).

Enter whole number only:           CASH
NASA Space Grant:        $
Other Federal:           $
                                                       NON-CASH                  TOTAL
Industry:                     $                   $                          $
Non-Profit Organizations:     $                   $                          $
State/Local Government:       $                   $                          $
Participants: (if they pay)   $                   $                          $
Other:                        $                   $                          $
TOTALS:                       $                   $                          $

Collaborative efforts (mark all that apply):

     In Same Department
     Other Departments in Same Institution
     Other Institution of Higher Education
     Community College
     K-12 Institution(s)
     Education Resource Centers
     Non-Profit Organizations
     Underrepresented Organizations
     Industry
     Community Partnership
OEPM – Precollege Program Form                                                                4

Give name of business and type of industry and describe collaboration: (limited to 1,900
characters – approx 30 lines)




NASA Installation(s) (mark all that apply):

     Ames Research Center
     Dryden Flight Research Center
     Goddard Space Flight Center
     Jet Propulsion Laboratory
     Johnson Space Center
     Kennedy Space Center
     Langley Research Center
     Glenn Research Center at Lewis Field
     Marshall Space Flight Center
     Stennis Space Center
     Wallops
     NASA Headquarters

NASA Installation Collaboration. Please specify: (limited to 1,900 characters – approx 30 lines)




NASA Directorates (mark all that apply):

     Science Mission Directorate
     Exploration Systems Mission Directorate
     Space Operations Mission Directorate
     Aeronautics Research Mission Directorate

List type of Collaboration: (limited to 1,900 characters – approx 30 lines)
OEPM – Precollege Program Form                                                                5

Other Space Grant Programs. Please Specify (List Consortium and name of program): (limited
to 1,900 characters – approx 30 lines)




Other Federal Government. Please Specify: (List Agency name) (limited to 1,900 characters –
approx 30 lines)




Other State Agencies. Please Specify: (limited to 1,900 characters – approx 30 lines)




Other Collaboration(s). Please Specify: (limited to 1,900 characters – approx 30 lines)




Additional Collaboration Information. Please Specify: (limited to 1,900 characters – approx 30 lines)




Scheduling
Mark all that apply:

     School Year
     Summer
     During School
     After School
     Weekend
OEPM – Precollege Program Form                  6

Activity and Participant Information
Activities (mark all that apply):

      Conference
      Science Fair/Exhibit
      Workshop
      Academic Program
      Other

This project was designed to promote:

Students (choose only one):

      Increase Awareness
      Expand Knowledge/Skills
      Career Guidance

Teachers (choose only one):

      Increase Awareness
      Expand Knowledge
      Improve Teaching Methods

Components (mark all that apply):

      Book
      Course Outline
      Course Revision
      Demonstration
      Field Trip
      Hands-on
      Lab Tour
      Lab
      Lesson Plan
      Mentors
      Other Components
      Problem Sets
      Research
      Role models for underrepresented groups
      Software
      Teacher's Manual
      Video
      Wall Sheets
OEPM – Precollege Program Form                                                                      7

Number of Teachers:
Enter number only:
                Male NOT                             Female NOT
              Underrepresented        Male          Underrepresented       Female          Unknown
                or Disabled      Underrepresented     or Disabled      Underrepresented   Race/Gender
Grades K-4
Grades 5-8
Grades 9-12



Number of Students:
Enter number only:
                Male NOT                             Female NOT
              Underrepresented        Male          Underrepresented       Female          Unknown
                or Disabled      Underrepresented     or Disabled      Underrepresented   Race/Gender
Grades K-4
Grades 5-8
Grades 9-12


Number of Parents:

Number of Administrators:

Number of Indirect Participants:

Are any kind of recruitment and/or retention strategies for members of underrepresented groups
in place? If so, please describe: (limited to 1,900 characters – approx 30 lines)




     Did the project exclusively target underrepresented minority and persons with
     disability? If yes, mark the group(s) targeted:

     African American
     Native American
     Hispanic
     Pacific Islander
OEPM – Precollege Program Form                                                                  8

With respect to underrepresented groups, note the level of project participation as Below, At, or
Exceeding the population represented in your state:

African American:            Below, At, or Exceeding
Hispanic:                    Below, At, or Exceeding
Pacific-Islander:            Below, At, or Exceeding
Native American:             Below, At, or Exceeding
Persons with Disabilities:   Below, At, or Exceeding

Was support provided for any of the following Standards? (mark all that apply):

      National Mathematics Standards
      National Science Standards
      National Geography Standards
      National Technology Standards
      State Frameworks
      Local Frameworks
      Other

Did you receive any other grants as a result of your NASA/OSGC grant? If so, please list
individually including grant amount, awarding institution, and title.




Overall Comments: (limited to 1,900 characters – approx 30 lines)




las – Revised, June, 2009