Centers of Research Excellence in Science and Technology (CREST) and Historically Black Colleges and Universities Research Infrastructure for Science and Engineering (HBCU-RISE) Monitoring System

Attachment A1

Centers of Research Excellence in Science and Technology (CREST)

Monitoring System

Table of Contents

CREST: Crosswalk 3

CREST: Number of Respondents, Frequency of Response, and Annual Hour Burden 20

CREST: Hour Burden Estimates by Each Form and Aggregate Hour Burdens 21

CREST: Estimates of Annualized Cost to Respondents for the Hour Burdens 22

CREST: Estimates of Costs to the Federal Government 23

CREST: Questions 24

CREST: Crosswalk

Common

Collection

Categories

Questions

Staff and Project Participant Characteristics¹

Project Implementation

Characteristics²

Project Outputs³

1. Center Information

Center Name

X

Street Address 1

Street Address 2

City

State

ZIP Code

X

Phone Number

X

Fax Number

X

E-mail Address

X

URL

X

Undergraduate Enrollment in CREST Program

X

Graduate Enrollment in CREST Program

X

2. Institutions

Institution Name

X

Type of Institution (Select one)

• Federal Government

• Industry

• Local Government

• Non-Profit

• State Government

• University or College

• Other

X

City

State/Region

Country

X

3. Participant Information

Principal Investigator (PI)/ Co-Principal Investigator (Co-PI)

Name (First Name, Middle Name, Last Name)

X

Did this participant leave the program in a prior reporting period, but is still associated with an accomplishment recorded this year?

• Yes (No other questions in the section are asked.)

• No (All other questions in the section are asked. Lead PI’s status defaults to “no.”)

X

Contact Information:

Institution

Address at institution

City

State/Region

Country

ZIP Code

Phone Number

Fax Number

E-mail Address

X

Gender: (Select one)

• Female

• Male

• Not Reported

X

Ethnicity: (Select one)

• Hispanic or Latino

• Not Hispanic or Latino

• Not Reported

X

Race: (Mark one or more)

• Black or African American

• American Indian or Alaska Native

• Native Hawaiian or Other Pacific Islander

• Asian

• White

• Not Reported

X

Disability: (Select one)

• Yes (Mark “yes” if any of the following apply:

• Deaf or serious difficulty hearing

• Blind or serious difficulty seeing even when wearing glasses

• Serious difficulty walking or climbing stairs

• Other serious disability related to a physical, mental, or emotional condition)

• No

• Do not wish to provide

X

Citizenship: (Select one)

• U. S. Citizen

• Permanent Resident

• Other Non-U.S. Citizen

• Not Reported

X

Thrust areas in which this participant participated during the current reporting period: (Mark all that apply)

• Thrust Area 1

• Thrust Area 2

• …

X

Faculty/Postdoc

X

Name (First Name, Middle Name, Last Name)

X

Did this participant leave the program in a prior reporting period, but is still associated with an accomplishment recorded this year?

• Yes (No other questions in the section are asked.)

• No (All other questions in the section are asked.)

X

Contact Information:

Institution

(Name, Type, City, State/Region)

Academic Rank (Select one)

• Assistant Professor

• Associate Professor

• Instructor or Lecturer

• Not Applicable

• Postdoctoral Associate

• Professor

Address at Institution

City

State/Region

Country

ZIP Code

Phone Number

Fax Number

E-mail Address

URL

X

Gender: (Select one)

• Female

• Male

• Not Reported

X

Ethnicity: (Select one)

• Hispanic or Latino

• Not Hispanic or Latino

• Not Reported

X

Race: (Mark one or more)

• Black or African American

• American Indian or Alaska Native

• Native Hawaiian or Other Pacific Islander

• Asian

• White

• Not Reported

X

Disability: (Select one)

• Yes (Mark “yes” if any of the following apply:

• Deaf or serious difficulty hearing

• Blind or serious difficulty seeing even when wearing glasses

• Serious difficulty walking or climbing stairs

• Other serious disability related to a physical, mental, or emotional condition)

• No

• Do not wish to provide

X

Citizenship: (Select one)

• U. S. Citizen

• Permanent Resident

• Other Non-U.S. Citizen

• Not Reported

X

Thrust areas in which this participant participated during the current reporting period: (Mark all that apply)

• Thrust Area 1

• Thrust Area 2

• …

X

Provide the total number of person-months this participant contributed to CREST during the reporting period by the source of funding.

NSF CREST

Other NSF

Other Federal Government

Other (please specify) __________

X

Student

Name (First Name, Middle Name, Last Name)

X

Did this participant leave the program in a prior reporting period, but is still associated with an accomplishment recorded this year?

• Yes (No other questions in the section are asked.)

• No (All other questions in the section are asked.)

X

Contact Information:

Institution (Name, Type, City, State/Region)

Address at Institution

City

State/Region

Country

ZIP Code

Phone Number

Fax Number

E-mail Address

URL

X

Gender: (Select one)

• Female

• Male

• Not Reported

X

Ethnicity: (Select one)

• Hispanic or Latino

• Not Hispanic or Latino

• Not Reported

X

Race: (Mark one or more)

• Black or African American

• American Indian or Alaska Native

• Native Hawaiian or Other Pacific Islander

• Asian

• White

• Not Reported

X

Disability: (Select one)

• Yes (Mark “yes” if any of the following apply:

• Deaf or serious difficulty hearing

• Blind or serious difficulty seeing even when wearing glasses

• Serious difficulty walking or climbing stairs

• Other serious disability related to a physical, mental, or emotional condition)

• No

• Do not wish to provide

X

Citizenship: (Select one)

• Not Reported

• Other Non-U.S. Citizen

• Permanent Resident

• U. S. Citizen

X

Thrust areas in which this participant participated during the current reporting period: (Mark all that apply)

• Thrust Area 1

• Thrust Area 2

• …

X

Provide the total number of person-months this participant contributed to CREST during the reporting period by the source of funding.

NSF CREST

Other NSF

Other Federal Government

Other (please specify) __________

X

Academic Level as of the September 1 20yy:

• Undergraduate Freshman

• Undergraduate Sophomore

• Undergraduate Junior

• Undergraduate Senior

• Undergraduate Other

• Graduate Masters

• Graduate Doctorate

• Graduate Other

• Graduated between July 1 and Sept. 1

X

If the student received a degree during current reporting period:

Degree Received: (Select one):

• Bachelor’s

• Master’s

• Ph.D.

Area of Study: (Select one)

• Agricultural Studies

• Chemical and Biological Sciences

• Computer and Information Sciences

• Crosscutting Programs

• Education

• Engineering

• English

• Environmental Sciences/ Renewable Natural Resources

• Geosciences

• International

• Life Sciences

• Mathematics

• Natural Sciences

• Physical Sciences

• Science Statistics

• Social, Behavioral Sciences

• Other

Title of Thesis or Dissertation

X

Which of the following kinds of financial support did this individual receive through the CREST program during the current reporting period? (Mark all that apply):

• Tuition

• Stipend(s)

• Other (please specify) __________

X

X

Did the student receive stipends from the CREST project for at least one academic term (including summer) during the current reporting period?

• Yes

• No

X

X

What is the student’s status at the end of the current reporting period? (Mark all that apply)

• Still in the CREST Program

• Postdoctoral Position

• Faculty Appointment

• Research Appointment

• Employment in private Industry

• Employment in public Industry

• Employment in K-12 Schools

• Other (please specify) __________

X

Provide the total number of person-months this individual contributed to CREST during the reporting period by the source of funding.

NSF CREST

Other NSF

Other Federal Government

Other (please specify) __________

X

Other Personnel

Name (First Name, Middle Name, Last Name)

X

Did this participant leave the program in a prior reporting period, but is still associated with an accomplishment recorded this year?

• Yes (No other questions in the section are asked.)

• No (All other questions in the section are asked.)

X

Contact Information:

Institution (Name, Type, City, State/Region)

Phone

Fax

E-mail

X

This individual fulfills the definition of a CREST participant (i.e., any individual who received the equivalent of at least one month's salary from the CREST project during the current reporting period).

• Yes

• No

X

Gender: (Select one)

• Female

• Male

• Not Reported

X

Ethnicity: (Select one)

• Hispanic or Latino

• Not Hispanic or Latino

• Not Reported

X

Race: (Mark one or more)

• Black or African American

• American Indian or Alaska Native

• Native Hawaiian or Other Pacific Islander

• Asian

• White

• Not Reported

X

Disability: (Select one)

• Yes (Mark “yes” if any of the following apply:

• Deaf or serious difficulty hearing

• Blind or serious difficulty seeing even when wearing glasses

• Serious difficulty walking or climbing stairs

• Other serious disability related to a physical, mental, or emotional condition)

• No

• Do not wish to provide

X

Citizenship (Select one):

• Not Reported

• Other Non-U.S. Citizen

• Permanent Resident

• U. S. Citizen

X

Thrust areas in which this participant participated during the current reporting period: (Mark all that apply)

• Thrust Area 1

• Thrust Area 2

• …

X

Contributor

Name (First Name, Middle Name, Last Name)

X

Institution (Name, Type, City, State/Region)

X

4. Proposals/Awards

Status

• Proposal

• Award

X

Title of Proposal/Award

X

Thrust Area (Select one)

• Thrust Area 1

• Thrust Area 2

• …

X

Funding Source Type:

• Federal

• Foundation

• Industry

• State

• University

• Other

X

Funding Source Name

X

Was this an NSF funding source? (Select one)

• Yes

• No

X

Type of Award: (Select one)

• Education

• Research

• Other

X

Center Award Amount (for Awards only)

X

Grant Award Amount (for Awards only)

X

Key Participants:

Primary Participant

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 2

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 3

…

X

Description of How CREST Contributed to This Accomplishment

X

5. Presentations

Presentation Title

X

Thrust Area (Select one)

• Thrust 1

• Thrust 2

• …

X

Presentation Location

Institution (Name, Type, City, State/Region)

OR

Conference name and location:

Conference Name

City

State

X

Approximate Audience Size

X

Presentation Date

X

Key Participants:

Primary Participant

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 2

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 3

…

X

Description of How CREST Contributed to This Presentation

X

6. Publications

Title

X

Thrust Area (Select one)

• Thrust Area 1

• Thrust Area 2

• …

X

Publication Name

X

Publication Type: (Select one)

• Article in Refereed Journal

• Book Chapter or Textbook

• Article in Public Proceedings

X

Status of Publication: (Select one)

• Accepted, Awaiting Publication

• Published (Volume, Year)

• Submitted, Under Review

• Other (please specify) __________

X

Citation:
Page #

URL

Other Citation

X

Key Participants:

Primary Participant

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 2

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 3

…

X

Description of How CREST Contributed to This Publication

X

7. Collaborative Projects

Collaborative Project Title

X

Thrust Area (Select one)

• Thrust Area 1

• Thrust Area 2

• …

X

Key Participants:

Primary Participant

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 2

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 3

…

X

Description of How CREST Contributed to This Collaborative Project

X

Collaborative Partner(s):

Institution 1

(Name, Type, City, State/Region)

Funding Source: (Mark all that apply)

• Federal

• Industry

• State

• University

• Other (please specify) __________

NSF Programs Related to This Partner:

(Mark all that apply)

(for institution type=University only)

NSF Program	Center Name
Centers for Learning and Teaching (CLT)
Centers for Ocean Science Education Excellence (COSEE)
Chemical Bonding Centers (CBC)
Engineering Research Centers (ERC)
Industry/University Cooperative Research Centers Program (I/UCRC)
Materials Research Science and Engineering Centers (MRSEC)
Science of Learning Centers (SLC)
Science and Technology Centers (STC)
Partnerships for Research and Education in Materials (PREM)
Integrative Graduate Education Traineeship Program (IGERT)
Alliances for Graduate Education and the Professoriate (AGEP)

Institution 2

…

X

Did the collaboration provide research for Undergraduates?

• Yes

• No

X

Research for Graduates?

• Yes

• No

X

Research for Postdocs?

• Yes

• No

X

Is this collaboration International?

• Yes

• No

If yes, was this collaboration planned as a part of your proposal or developed later during the award period? (select one)

• Proposal

• Award

X

8. Patents

Patent Title

X

Thrust Area: (Select one)

• Thrust Area 1

• Thrust Area 2

• …

X

Year Submitted

X

Application Number

X

Allowed: (Select one)

• Yes

• No

X

Patent Number

X

Key Participants:

Primary Participant

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 2

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 3

…

X

Description of How CREST Contributed to This Collaborative Project

X

9. Activities

Activity Title

X

Thrust Area: (Select one)

• Thrust Area 1

• Thrust Area 2

• …

X

Activity Type: (Select one)

• Research Activities/Findings

• Education and HR Activities/Accomplishments

• Attracting/Attaining/Retaining Students

• Integrating Education and Research

• Working With K—12 Students

• Facilitating the Transfer of Knowledge

• Developing or Purchasing Equipment/Facilities

X

Activity Start Date

X

Activity End Date

X

Institutions:

Institution 1

(Name, Type, City, State/Region)

Institution 2

…

X

Key Participants:

Primary Participant

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 2

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 3

…

X

Highlights of outstanding accomplishments:
(If this is a continuation of an activity from last year, please explain the changes in the direction or level of activity from the previous year.)

X

Impact of Activity on Faculty, Students and/or Scientific Community

X

Description of How CREST Contributed to This Activity

X

10. Conferences Organized

X

Conference Title

X

Conference Topic

X

Thrust Area: (Select one)

• Thrust Area 1

• Thrust Area 2

• …

X

Conference Start Date

X

Conference End Date

X

Conference Location:

Institution (Name, Type, City, State/Region)

OR

Conference name and location:

Conference Name

City

State

X

Invited Speakers

X

Undergraduate Participant Count

X

Graduate Participant Count

X

Postdoc Participant Count

X

Faculty Participant Count

X

Other Sponsoring Organization(s)

X

Conference URL

X

Key Participants:

Primary Participant

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 2

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 3

…

X

Description of How CREST Contributed to This Conference

X

11. Functional Budget

Budget data per budget source (including thrusts and general CREST Sources):

Funds Allocated	Source
	NSF CREST	Other NSF	Other Federal Government	State	Local Government	Industry	University	Other	Total
Thrust 1
Thrust 2
…
Education and Outreach Thrust
Crest Administration
Education Coordinator
Outreach and Knowledge Transfer Coordinator
Total

X

CREST: Number of Respondents, Frequency of Response, and Annual Hour Burden

The estimated average number of annual respondents is 37 (23 CREST center PIs/program coordinators and 14 HBCU-RISE award PIs/program coordinators), with an estimated annual response burden of 1,374 hours. The Web-based data collection is an annual activity of the CREST program. The respondents are either PIs or program coordinators. One PI or program coordinator per award completes the questionnaire The estimated annual hour burden per respondent was determined using the burden information reported by respondents from the last three collection cycles.

The burden estimate is outlined below:

Respondent Type	Estimated Average Annual No. of Respondents	Estimated Average Annual Burden Hours Per Respondent	Estimated Annual Burden Hour Total
CREST center PIs/program coordinators	23	50	1,150
HBCU-RISE award PIs/program coordinators	14	16	224
Total	37	37.14	1,374

CREST: Hour Burden Estimates by Each Form and Aggregate Hour Burdens

There is only one form. This form accounts for the entire annual response burden of 1,374 hours. The annual burden by form was calculated as follows:

 

Form Type	Respondent Type	No. of Respondents	Burden Hours Per Respondent	Total Burden Hours
CREST data collection form	PIs/program coordinators	37	37.14	1,374
Total		37		1,374

CREST: Estimates of Annualized Cost to Respondents for the Hour Burdens

The overall annualized cost to the respondents is estimated to be $56,341. The following table shows the annualized estimate of cost to PI/program coordinator respondents, who are generally university professors. This estimated hourly rate is based on a report from the American Association of University Professors, “Annual Report on the Economic Status of the Profession, 2011-12,” Academe, March–April 2012, Survey Report Table 4. According to this report, the average salary of an associate professor across all types of doctoral-granting institutions (public, private-independent, religiously affiliated) was $86,319. When divided by the number of standard annual work hours (2,080), this calculates to approximately $41 per hour.

Respondent Type	No. of Respondents	Burden Hours Per Respondent	Average Hourly Rate	Estimated Annual Cost
PIs/program coordinators	37	37.14	$41	$56,341
Total	37			$56,341

CREST: Estimates of Costs to the Federal Government

Computing the annualized cost to NSF for the CREST data collection was done by taking the budgets for three years and calculating the costs for each of the following operational activities involved in producing, maintaining, and conducting the data collection:

Operational Activities	Cost Over Three Years
System Development (includes initial development of the database and Web-based application, and later changes requested by the program, e.g., increased reporting tools, additional validations)	$357,166
System Maintenance, Updates, and Technical Support (system requires updates each year before opening the collection; maintenance is required to keep the system current with technology, e.g., database servers, operating systems)	$178,583
Data Collection Opening and Support (e.g., online and telephone support to respondents and contacting respondents to encourage completion of the questions), Reporting (as defined by HRD), and Followup Activities (e.g., providing data to other consultants)	$134,157
Three-Year Total for All Operational Activities	$669,906

The annualized cost was computed as one-third of the total three-year costs; thus, the annualized cost to NSF for the CREST data collection is $223,302.

CREST: Questions

1. Center Information

Center Name

Street Address 1

Street Address 2

City

State

ZIP Code

Phone Number

Fax Number

E-mail Address

URL

Undergraduate Enrollment in CREST Program

Graduate Enrollment in CREST Program

2. Institutions

Institution Name

Type of Institution (Select one)

• Federal Government

• Industry

• Local Government

• Non-Profit

• State Government

• University or College

• Other

City

State/Region

Country

3. Participant Information

Principal Investigator (PI)/ Co-Principal Investigator (Co-PI)

Name (First Name, Middle Name, Last Name)

Did this participant leave the program in a prior reporting period, but is still associated with an accomplishment recorded this year?

• Yes (No other questions in the section are asked.)

• No (All other questions in the section are asked. Lead PI’s status defaults to “no.”)

Contact Information:

Institution

Address at institution

City

State/Region

Country

ZIP Code

Phone Number

Fax Number

E-mail Address

Gender: (Select one)

• Female

• Male

• Not Reported

Ethnicity: (Select one)

• Hispanic or Latino

• Not Hispanic or Latino

• Not Reported

Race: (Mark one or more)

• Black or African American

• American Indian or Alaska Native

• Native Hawaiian or Other Pacific Islander

• Asian

• White

• Not Reported

Disability: (Select one)

• Yes (Mark “yes” if any of the following apply:

• Deaf or serious difficulty hearing

• Blind or serious difficulty seeing even when wearing glasses

• Serious difficulty walking or climbing stairs

• Other serious disability related to a physical, mental, or emotional condition)

• No

• Do not wish to provide

Citizenship: (Select one)

• U. S. Citizen

• Permanent Resident

• Other Non-U.S. Citizen

• Not Reported

Thrust areas in which this participant participated during the current reporting period: (Mark all that apply)

• Thrust Area 1

• Thrust Area 2

• …

Faculty/Postdoc

Name (First Name, Middle Name, Last Name)

Did this participant leave the program in a prior reporting period, but is still associated with an accomplishment recorded this year?

• Yes (No other questions in the section are asked.)

• No (All other questions in the section are asked.)

Contact Information:

Institution

(Name, Type, City, State/Region)

Academic Rank (Select one)

• Assistant Professor

• Associate Professor

• Instructor or Lecturer

• Not Applicable

• Postdoctoral Associate

• Professor

Address at Institution

City

State/Region

Country

ZIP Code

Phone Number

Fax Number

E-mail Address

URL

Gender: (Select one)

• Female

• Male

• Not Reported

Ethnicity: (Select one)

• Hispanic or Latino

• Not Hispanic or Latino

• Not Reported

Race: (Mark one or more)

• Black or African American

• American Indian or Alaska Native

• Native Hawaiian or Other Pacific Islander

• Asian

• White

• Not Reported

Disability: (Select one)

• Yes (Mark “yes” if any of the following apply:

• Deaf or serious difficulty hearing

• Blind or serious difficulty seeing even when wearing glasses

• Serious difficulty walking or climbing stairs

• Other serious disability related to a physical, mental, or emotional condition)

• No

• Do not wish to provide

Citizenship: (Select one)

• U. S. Citizen

• Permanent Resident

• Other Non-U.S. Citizen

• Not Reported

Thrust areas in which this participant participated during the current reporting period: (Mark all that apply)

• Thrust Area 1

• Thrust Area 2

• …

Provide the total number of person-months this participant contributed to CREST during the reporting period by the source of funding.

NSF CREST

Other NSF

Other Federal Government

Other (please specify) __________

Student

Name (First Name, Middle Name, Last Name)

Did this participant leave the program in a prior reporting period, but is still associated with an accomplishment recorded this year?

• Yes (No other questions in the section are asked.)

• No (All other questions in the section are asked.)

Contact Information:

Institution (Name, Type, City, State/Region)

Address at Institution

City

State/Region

Country

ZIP Code

Phone Number

Fax Number

E-mail Address

URL

Gender: (Select one)

• Female

• Male

• Not Reported

Ethnicity: (Select one)

• Hispanic or Latino

• Not Hispanic or Latino

• Not Reported

Race: (Mark one or more)

• Black or African American

• American Indian or Alaska Native

• Native Hawaiian or Other Pacific Islander

• Asian

• White

• Not Reported

Disability: (Select one)

• Yes (Mark “yes” if any of the following apply:

• Deaf or serious difficulty hearing

• Blind or serious difficulty seeing even when wearing glasses

• Serious difficulty walking or climbing stairs

• Other serious disability related to a physical, mental, or emotional condition)

• No

• Do not wish to provide

Citizenship: (Select one)

• Not Reported

• Other Non-U.S. Citizen

• Permanent Resident

• U. S. Citizen

Thrust areas in which this participant participated during the current reporting period: (Mark all that apply)

• Thrust Area 1

• Thrust Area 2

• …

Provide the total number of person-months this participant contributed to CREST during the reporting period by the source of funding.

NSF CREST

Other NSF

Other Federal Government

Other (please specify) __________

Academic Level as of the September 1 20yy:

• Undergraduate Freshman

• Undergraduate Sophomore

• Undergraduate Junior

• Undergraduate Senior

• Undergraduate Other

• Graduate Masters

• Graduate Doctorate

• Graduate Other

• Graduated between July 1 and Sept. 1

If the student received a degree during current reporting period:

Degree Received: (Select one):

• Bachelor’s

• Master’s

• Ph.D.

Area of Study: (Select one)

• Agricultural Studies

• Chemical and Biological Sciences

• Computer and Information Sciences

• Crosscutting Programs

• Education

• Engineering

• English

• Environmental Sciences/ Renewable Natural Resources

• Geosciences

• International

• Life Sciences

• Mathematics

• Natural Sciences

• Physical Sciences

• Science Statistics

• Social, Behavioral Sciences

• Other

Title of Thesis or Dissertation

Which of the following kinds of financial support did this individual receive through the CREST program during the current reporting period? (Mark all that apply):

• Tuition

• Stipend(s)

• Other (please specify) __________

Did the student receive stipends from the CREST project for at least one academic term (including summer) during the current reporting period?

• Yes

• No

What is the student’s status at the end of the current reporting period? (Mark all that apply)

• Still in the CREST Program

• Postdoctoral Position

• Faculty Appointment

• Research Appointment

• Employment in private Industry

• Employment in public Industry

• Employment in K-12 Schools

• Other (please specify) __________

Provide the total number of person-months this individual contributed to CREST during the reporting period by the source of funding.

NSF CREST

Other NSF

Other Federal Government

Other (please specify) __________

Other Personnel

Name (First Name, Middle Name, Last Name)

Did this participant leave the program in a prior reporting period, but is still associated with an accomplishment recorded this year?

• Yes (No other questions in the section are asked.)

• No (All other questions in the section are asked.)

Contact Information:

Institution (Name, Type, City, State/Region)

Phone

Fax

E-mail

This individual fulfills the definition of a CREST participant (i.e., any individual who received the equivalent of at least one month's salary from the CREST project during the current reporting period).

• Yes

• No

Gender: (Select one)

• Female

• Male

• Not Reported

Ethnicity: (Select one)

• Hispanic or Latino

• Not Hispanic or Latino

• Not Reported

Race: (Mark one or more)

• Black or African American

• American Indian or Alaska Native

• Native Hawaiian or Other Pacific Islander

• Asian

• White

• Not Reported

Disability: (Select one)

• Yes (Mark “yes” if any of the following apply:

• Deaf or serious difficulty hearing

• Blind or serious difficulty seeing even when wearing glasses

• Serious difficulty walking or climbing stairs

• Other serious disability related to a physical, mental, or emotional condition)

• No

• Do not wish to provide

Citizenship (Select one):

• Not Reported

• Other Non-U.S. Citizen

• Permanent Resident

• U. S. Citizen

Thrust areas in which this participant participated during the current reporting period: (Mark all that apply)

• Thrust Area 1

• Thrust Area 2

• …

Contributor

Name (First Name, Middle Name, Last Name)

Institution (Name, Type, City, State/Region)

4. Proposals/Awards

Status

• Proposal

• Award

Title of Proposal/Award

Thrust Area (Select one)

• Thrust Area 1

• Thrust Area 2

• …

Funding Source Type:

• Federal

• Foundation

• Industry

• State

• University

• Other

Funding Source Name

Was this an NSF funding source? (Select one)

• Yes

• No

Type of Award: (Select one)

• Education

• Research

• Other

Center Award Amount (for Awards only)

Grant Award Amount (for Awards only)

Key Participants:

Primary Participant

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 2

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 3

…

Description of How CREST Contributed to This Accomplishment

5. Presentations

Presentation Title

Thrust Area (Select one)

• Thrust 1

• Thrust 2

• …

Presentation Location

Institution (Name, Type, City, State/Region)

OR

Conference name and location:

Conference Name

City

State

Approximate Audience Size

Presentation Date

Key Participants:

Primary Participant

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 2

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 3

…

Description of How CREST Contributed to This Presentation

6. Publications

Title

Thrust Area (Select one)

• Thrust Area 1

• Thrust Area 2

• …

Publication Name

Publication Type: (Select one)

• Article in Refereed Journal

• Book Chapter or Textbook

• Article in Public Proceedings

Status of Publication: (Select one)

• Accepted, Awaiting Publication

• Published (Volume, Year)

• Submitted, Under Review

• Other (please specify) __________

Citation:
Page #

URL

Other Citation

Key Participants:

Primary Participant

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 2

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 3

…

Description of How CREST Contributed to This Publication

7. Collaborative Projects

Collaborative Project Title

Thrust Area (Select one)

• Thrust Area 1

• Thrust Area 2

• …

Key Participants:

Primary Participant

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 2

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 3

…

Description of How CREST Contributed to This Collaborative Project

Collaborative Partner(s):

Institution 1

(Name, Type, City, State/Region)

Funding Source: (Mark all that apply)

• Federal

• Industry

• State

• University

• Other (please specify) __________

NSF Programs Related to This Partner:

(Mark all that apply)

(for institution type=University only)

NSF Program	Center Name
Centers for Learning and Teaching (CLT)
Centers for Ocean Science Education Excellence (COSEE)
Chemical Bonding Centers (CBC)
Engineering Research Centers (ERC)
Industry/University Cooperative Research Centers Program (I/UCRC)
Materials Research Science and Engineering Centers (MRSEC)
Science of Learning Centers (SLC)
Science and Technology Centers (STC)
Partnerships for Research and Education in Materials (PREM)
Integrative Graduate Education Traineeship Program (IGERT)
Alliances for Graduate Education and the Professoriate (AGEP)

Institution 2

…

Did the collaboration provide research for Undergraduates?

• Yes

• No

Research for Graduates?

• Yes

• No

Research for Postdocs?

• Yes

• No

Is this collaboration International?

• Yes

• No

If yes, was this collaboration planned as a part of your proposal or developed later during the award period? (select one)

• Proposal

• Award

8. Patents

Patent Title

Thrust Area: (Select one)

• Thrust Area 1

• Thrust Area 2

• …

Year Submitted

Application Number

Allowed: (Select one)

• Yes

• No

Patent Number

Key Participants:

Primary Participant

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 2

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 3

…

Description of How CREST Contributed to This Collaborative Project

9. Activities

Activity Title

Thrust Area: (Select one)

• Thrust Area 1

• Thrust Area 2

• …

Activity Type: (Select one)

• Research Activities/Findings

• Education and HR Activities/Accomplishments

• Attracting/Attaining/Retaining Students

• Integrating Education and Research

• Working With K—12 Students

• Facilitating the Transfer of Knowledge

• Developing or Purchasing Equipment/Facilities

Activity Start Date

Activity End Date

Institutions:

Institution 1

(Name, Type, City, State/Region)

Institution 2

…

Key Participants:

Primary Participant

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 2

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 3

…

Highlights of outstanding accomplishments:
(If this is a continuation of an activity from last year, please explain the changes in the direction or level of activity from the previous year.)

Impact of Activity on Faculty, Students and/or Scientific Community

Description of How CREST Contributed to This Activity

10. Conferences Organized

Conference Title

Conference Topic

Thrust Area: (Select one)

• Thrust Area 1

• Thrust Area 2

• …

Conference Start Date

Conference End Date

Conference Location:

Institution (Name, Type, City, State/Region)

OR

Conference name and location:

Conference Name

City

State

Invited Speakers

Undergraduate Participant Count

Graduate Participant Count

Postdoc Participant Count

Faculty Participant Count

Other Sponsoring Organization(s)

Conference URL

Key Participants:

Primary Participant

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 2

Name (First Name, Middle Name, Last Name)

Institution

Participant/Contributor 3

…

Description of How CREST Contributed to This Conference

11. Functional Budget

Budget data per budget source (including thrusts and general CREST Sources):

Funds Allocated	Source
	NSF CREST	Other NSF	Other Federal Government	State	Local Government	Industry	University	Other	Total
Thrust 1
Thrust 2
…
Education and Outreach Thrust
Crest Administration
Education Coordinator
Outreach and Knowledge Transfer Coordinator
Total

1 Elements of these characteristics include: Name, address, date of birth, gender, ethnicity, race, disability status, class, major, grade point average, yearly fellowship or stipend amount, or project role.

2 Elements of these characteristics include: Sources and amount of funds, fellowships, scholarships, traineeships, partnerships, training, and research methods.

3 Elements of these characteristics include: Research findings, publications, presentations, degrees granted, and educational materials.

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