Form ED-917 University Centers

Economic Development Administration

GPRA Data Collection Form

University Centers

PART I

Date ___________________________________________________________________

Recipient Name ___________________________________________________________________

Full Address ___________________________________________________________________

Authorized Contact ___________________________________________________________________

Telephone ____________________________ Fax ______________________________

Email (not optional) ___________________________________________________________________

EDA Investment Technical Assistance - University Center

Investment Number ___________________________________________________________________

Award Period ___________________ to _________________

Description of Activities: Technology _____ Economic Development _____

PART II

Recipients are required to report the following:

a. Number of University Center (UC) clients provided 8 or more hours of technical assistance. __________

(count only clients who received UC technical assistance; count only once even if it received assistance for more than one task)

b. Number of UC clients reported in a taking action as a result of the assistance facilitated by UC. __________

c. Number of those actions taken by UC clients reported in b that achieved the expected results. __________

(Please attach a list of clients and actions that achieved expected results)

d. Estimated number of jobs created or retained as a result of c. ______________

e. Estimated amount of private sector investment generated as a result of c. ______________

f. Estimated amount of public sector investment generated as a result of c. ______________

g. Other economic benefits resulting from technical assistance (written examples, dollar amounts can be included as part of the example).

________________________________________________________________________________________________

________________________________________________________________________________________________

h. Categorize type of assistance provided:

Quantity Quantity

Economic development plan ____ Partnership Strategies ____

Strategic partnering to Project Management ____

Public-or private sector entities ____ GIS Service ____

Client Services ____ Studies ____

Technology Transfer ____ Business Sector Services ____

OMB Approved ED-917

OMB Control Number 0610-0098

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