Partnership Award Application

1st Organization
Name of Organization involved in partnership*
Key Contact*
First Last
City*
City
Email*
Phone*
Website
Brief description of type of organization*
2nd Organization
Name of Organization involved in partnership
Key Contact
First Last
City
City
Email
Phone
Website
Brief description of type of organization
Nominator:
Name*
First Last
Relationship to nominee*

(can be self nomination)
Employer*
Address*
City State
Email*
Phone*
Be sure to provide examples/evidence of how the partnership addresses each of the areas below.
How does the partnership create deeper understanding by students or community members of STEM topics?
How does the partnership promote active engagement by students or community members?
How does the partnership address an area of need or concern in community or state?
How does the partnership provide an innovative approach to STEM?
How does the partnership build capacity for STEM in the community or across the state?
How does the partnership provide a replicable model?
Explain how the partnership has developed a successful collaboration.
Estimate the number of students or community members served by this program and information on how long the partnership has been in place.
Additional comments about partnership:
Security Check

1st Organization