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) and Historically Black Colleges and Universities Research Infrastructure for Science and Engineering (HBCU-RISE)

Monitoring System

Table of Contents

CREST/HBCU-RISE: Crosswalk 3

CREST/HBCU-RISE: Number of Respondents, Frequency of Response, and Annual Hour Burden 20

CREST/HBCU-RISE: Hour Burden Estimates by Each Form and Aggregate Hour Burdens 21

CREST/HBCU-RISE: Estimates of Annualized Cost to Respondents for the Hour Burdens 22

CREST/HBCU-RISE: Estimates of Costs to the Federal Government 23

CREST/HBCU-RISE: Questions 24

CREST/HBCU-RISE: Crosswalk

Highlighted in blue are items which will be discontinued during the period of the renewal.

Highlighted in yellow are proposed new items.

Highlighted in grey are item wordings which NSF proposes, with OMB approval, to change. Previous text is marked with strikethrough.

Common

Collection

Categories

Questions

Staff and Project Participant Characteristics¹

Project Implementation

Characteristics²

Project Outputs³

1. Center/Award Information

Center/Award 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

Number of undergraduate students supported by the CREST center/HBCU-RISE award during the current reporting period

X

X

Number of graduate students supported by the CREST center/HBCU-RISE award during the current reporting period

X

X

2. Institutions

Institution Name

X

Type of Institution (Select one)

• Federal Government

• Industry

• Local Government

• Non-Profit

• Other

• State Government

• University or College

X

City

State/Region

Country

X

3. Participants

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

Name (First Name, Middle Name, Last Name)

X

Cited-Only Information

Is this person a former participant who is listed only because he or she is cited on a proposal, award, presentation, collaborative project, patent, activity, and/or conference that is listed for the current reporting period?

• 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 (Name, Type, City, State/Region, Country)

Address at Institution

City

State/Region

Country

ZIP Code

Phone Number

Fax Number

E-mail Address

X

Proposed new item:

If you have an Open Researcher and Contributor ID (ORCID), please provide it in the space below

• My ORCID is [provide space for ORCID inclusion]

• I do not have an ORCID

• Prefer not to provide

Demographic Information

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 Status: (Select one)

• Yes (Select 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

Mark one or more thrust areas in which this participant participated during the current reporting period:

• Education and Outreach

• Thrust Area 1

• Thrust Area 2

• …

X

Faculty/Postdoc

Name (First Name, Middle Name, Last Name)

X

Cited-Only Information

Is this person a former participant who is listed only because he or she is cited on a proposal, award, presentation, collaborative project, patent, activity, and/or conference that is listed for the current reporting period?

• 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, Country)

Academic Rank: (Select one)

• Professor

• Associate Professor

• Assistant Professor

• Instructor or Lecturer

• Postdoctoral Associate

• Not Applicable

Address at Institution

City

State/Region

Country

ZIP Code

Phone Number

Fax Number

E-mail Address

URL

X

Proposed new item:

If you have an Open Researcher and Contributor ID (ORCID), please provide it in the space below

• My ORCID is [provide space for ORCID inclusion]

• I do not have an ORCID

• Prefer not to provide

Demographic Information

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 Status: (Select one)

• Yes (Select 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

Mark one or more thrust areas in which this participant participated during the current reporting period:

• Education and Outreach

• Thrust Area 1

• Thrust Area 2

• …

• N/A

X

Support

Provide the number of months of direct or indirect support this participant received from the CREST center/HBCU-RISE award during the current reporting period.

X

Student

Name (First Name, Middle Name, Last Name)

X

Cited-Only Information

Is this person a former participant who is listed only because he or she is cited on a proposal, award, presentation, collaborative project, patent, activity, and/or conference that is listed for the current reporting period?

• 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, Country)

Address at Institution

City

State/Region

Country

ZIP Code

Phone Number

Fax Number

E-mail Address

URL

X

Demographic Information

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 Status: (Select one)

• Yes (Select 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

• Permanent Resident

• Other Non-U.S. Citizen

• U. S. Citizen

X

Thrust Areas

Mark one or more thrust areas in which this participant participated during the current reporting period:

• Education and Outreach

• Thrust Area 1

• Thrust Area 2

• …

• N/A

X

Student-Specific Information

Academic Level as of the September 1 20yy:

• Graduated between July 1 and Sept. 1

• Graduate Doctorate

• Graduate Master’s

• Graduate Other

• Undergraduate Senior

• Undergraduate Junior

• Undergraduate Sophomore

• Undergraduate Freshman

• Undergraduate Other

X

X

Area of Study: (Select one)

• Agricultural Sciences

• 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

X

If the student received a degree during the current reporting period, enter the degree received, area of study, and (for students receiving a master’s degree or Ph.D.) title of the thesis or dissertation.

Degree Received: (Select one):

• Bachelor’s

• Master’s

• Ph.D.

Title of Thesis or Dissertation

X

X

Which of the following kinds of financial support did the student receive through the CREST center/HBCU-RISE award during the current reporting period? (Mark one or more):

• Tuition

• Stipend

• Other (Please specify): __________

Financial Support Source: (Select one)

• NSF CREST/HBCU-RISE program

• Other (Please specify): __________

X

Indicate the number of academic terms of support received through the CREST center/HBCU-RISE award during the current reporting period, by type of support:

• Tuition

• Stipend

• Other

X

What was the student’s status at the end of the current reporting period? (Mark one or more)

• 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

X

Other Personnel

Name (First Name, Middle Name, Last Name)

X

Cited-Only Information

Is this person a former participant who is listed only because he or she is cited on a proposal, award, presentation, collaborative project, patent, activity, and/or conference that is listed for the current reporting period?

• 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, Country)

Phone

Fax

E-mail Address

X

Mark this checkbox if 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).

X

Demographic Information

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 Status: (Select one)

• Yes (Select 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

• Permanent Resident

• Other Non-U.S. Citizen

• U. S. Citizen

X

Thrust Areas

Mark one or more thrust areas in which this participant participated during the current reporting period:

• Education and Outreach

• Thrust Area 1

• Thrust Area 2

• …

• N/A

X

Contributor

Name (First Name, Middle Name, Last Name)

X

Contact Information:

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

X

4. Accomplishments

Proposals/Awards

Status

• Proposal

• Award

X

Title

X

Thrust Area: (Select one)

• Education and Outreach

• Thrust Area 1

• Thrust Area 2

• …

X

Funding Source Type: (Select one)

• Federal

• State

• University

• Industry

• Foundation

• Other

X

Funding Source Name

X

Was this an NSF funding source? (Select one)

• Yes

• No

X

Type of Award: (Select one)

• Research

• Education

• 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/HBCU-RSE Contributed to This Accomplishment

X

Presentations

Presentation Title

X

Thrust Area (Select one)

• Education and Outreach

• Thrust 1

• Thrust 2

• …

X

Presentation Location

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

OR

Conference Name

Conference Location (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/HBCU-RISE Contributed to This Presentation

X

Publications

Publication Title

X

Thrust Area (Select one)

• Education and Outreach

• Thrust Area 1

• Thrust Area 2

• …

X

Publication Name

X

Publication Type: (Select one)

• Book chapter or textbook

• Article in refereed journal

• Article in public proceedings

X

Status of Publication: (Select one)

• Accepted, Awaiting Publication

• Other (Please specify): __________

• Published (Volume, Year)

• Submitted, Under Review

X

Citation:

Page Number

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/HBCU-RISE Contributed to This Publication

X

Collaborative Projects

Collaborative Project Title

X

Thrust Area (Select one)

• Education and Outreach

• 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/HBCU-RISE Contributed to This Collaborative Project

X

Collaborative Partner(s):

Institution 1 (Name, Type, City, State/Region, Country)

Funding Source: (Mark one or more)

• Federal

• State

• University

• Industry

• Other (Please specify): __________

NSF Programs Related to This Partner: (Mark one or more)

(for institution type=University only)

NSF intends to revise the list of programs about which respondents are prompted to provide information as indicated in the table below.

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? (Select one)

• Yes

• No

X

X

Research for graduates? (Select one)

• Yes

• No

X

X

Research for postdocs? (Select one)

• Yes

• No

X

X

Is this collaboration international? (Select one)

• 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 period

X

X

Patents

Patent Title

X

Thrust Area: (Select one)

• Education and Outreach

• 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/HBCU-RISE Contributed to This Patent

X

Activities

Activity Title

X

Thrust Area: (Select one)

• Education and Outreach

• 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

• Safety activities

X

Activity Start Date

X

Activity End Date

X

Institutions Involved:

Institution 1 (Name, Type, City, State/Region, Country)

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

X

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

X

Description of How CREST/HBCU-RISE Contributed to This Activity

X

Conferences Organized

X

Conference Title

X

Conference Topic

X

Thrust Area: (Select one)

• Education and Outreach

• Thrust Area 1

• Thrust Area 2

• …

X

Conference Start Date

X

Conference End Date

X

Conference Location:

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

OR

Conference Location (City, State)

X

Invited Speakers

X

Undergraduate Participant Count

X

X

Graduate Participant Count

X

X

Postdoc Participant Count

X

X

Faculty Participant Count

X

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/HBCU-RISE Contributed to This Conference

X

5. Functional Budget

Budget data by source of support and functional area:

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

X

CREST/HBCU-RISE: Number of Respondents, Frequency of Response, and Annual Hour Burden

The estimated average number of annual respondents is 46 (33 CREST center PIs/program coordinators and 13 HBCU-RISE award PIs/program coordinators), with an estimated annual response burden of 1,476 hours. The Web-based data collection is an annual activity of the CREST/HBCU-RISE program. The respondents are either PIs or program coordinators. Generally, 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 two 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	33	40	1,320
HBCU-RISE award PIs/program coordinators	13	12	156
Total	46	32.08	1,476

CREST/HBCU-RISE: 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 1,476 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/HBCU-RISE data collection form	PIs/program coordinators	46	32.08	1476
Total		46		1,476

CREST/HBCU-RISE: Estimates of Annualized Cost to Respondents for the Hour Burdens

The overall annualized cost to the respondents is estimated to be $78,211. The following table shows the annualized estimate of cost to PI/program coordinator respondents, who are generally university professors. The estimated hourly rate is based on a report from the American Association of University Professors, “The Annual Report on the Economic Status of the Profession, 2020-2021,” Survey Report Table 1. According to this report, the average salary across all academic ranks and across all types of doctoral-granting institutions (public, private-independent, religiously affiliated) was $109,428. When divided by the number of standard annual work hours (2,080), this calculates to approximately $53 per hour. That rate and the corresponding total annual cost are indicated in the table below:

Respondent Type	No. of Respondents	Burden Hours Per Respondent	Average Hourly Rate	Estimated Annual Cost
PIs/program coordinators	46	32.08	$53	$78,211
Total	46			$78,211

CREST/HBCU-RISE: Estimates of Costs to the Federal Government

Computing the annualized cost to NSF for the CREST/HBCU-RISE data collection was done by taking the projected budget for the next three years and calculating the cost 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)	$164,197
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)	$295,556
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 Follow-up Activities (e.g., providing data to other consultants)	$197,037
Three-Year Total for All Operational Activities	$656,790

The annualized cost was computed as one-third of the total three-year cost; thus, the annualized cost to NSF for the CREST/HBCU-RISE data collection is $218,930.

CREST/HBCU-RISE: Questions

Highlighted in blue are items which will be discontinued during the period of the renewal.

Highlighted in yellow are proposed new items.

Highlighted in grey are item wordings which NSF proposes, with OMB approval, to change. Previous text is marked with strikethrough.

1. Center/Award Information

Center/Award Name

Street Address 1

Street Address 2

City

State

ZIP Code

Phone Number

Fax Number

E-mail Address

URL

Number of undergraduate students supported by the CREST center/HBCU-RISE award during the current reporting period

Number of graduate students supported by the CREST center/HBCU-RISE award during the current reporting period

2. Institutions

Institution Name

Type of Institution (Select one)

• Federal Government

• Industry

• Local Government

• Non-Profit

• Other

• State Government

• University or College

City

State/Region

Country

3. Participants

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

Name (First Name, Middle Name, Last Name)

Cited-Only Information

Is this person a former participant who is listed only because he or she is cited on a proposal, award, presentation, collaborative project, patent, activity, and/or conference that is listed for the current reporting period?

• 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 (Name, Type, City, State/Region, Country)

Address at Institution

City

State/Region

Country

ZIP Code

Phone Number

Fax Number

E-mail Address

Proposed new item:

If you have an Open Researcher and Contributor ID (ORCID), please provide it in the space below

• My ORCID is [provide space for ORCID inclusion]

• I do not have an ORCID

• Prefer not to provide

Demographic Information

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 Status: (Select one)

• Yes (Select 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

Mark one or more thrust areas in which this participant participated during the current reporting period:

• Education and Outreach

• Thrust Area 1

• Thrust Area 2

• …

Faculty/Postdoc

Name (First Name, Middle Name, Last Name)

Cited-Only Information

Is this person a former participant who is listed only because he or she is cited on a proposal, award, presentation, collaborative project, patent, activity, and/or conference that is listed for the current reporting period?

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

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

Proposed new item: If you have an Open Researcher and Contributor ID (ORCID), please provide it in the space below

• My ORCID is [provide space for ORCID inclusion]

• I do not have an ORCID

• Prefer not to provide

Contact Information:

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

Academic Rank: (Select one)

• Professor

• Associate Professor

• Assistant Professor

• Instructor or Lecturer

• Postdoctoral Associate

• Not Applicable

Address at Institution

City

State/Region

Country

ZIP Code

Phone Number

Fax Number

E-mail Address

URL

Demographic Information

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 Status: (Select one)

• Yes (Select 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

Mark one or more thrust areas in which this participant participated during the current reporting period:

• Education and Outreach

• Thrust Area 1

• Thrust Area 2

• …

• N/A

Support

Provide the number of months of direct or indirect support this participant received from the CREST center/HBCU-RISE award during the current reporting period.

Student

Name (First Name, Middle Name, Last Name)

Cited-Only Information

Is this person a former participant who is listed only because he or she is cited on a proposal, award, presentation, collaborative project, patent, activity, and/or conference that is listed for the current reporting period?

• 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, Country)

Address at Institution

City

State/Region

Country

ZIP Code

Phone Number

Fax Number

E-mail Address

URL

Demographic Information

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 Status: (Select one)

• Yes (Select 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

• Permanent Resident

• Other Non-U.S. Citizen

• U. S. Citizen

Thrust Areas

Mark one or more thrust areas in which this participant participated during the current reporting period:

• Education and Outreach

• Thrust Area 1

• Thrust Area 2

• …

• N/A

Student-Specific Information

Academic Level as of the September 1 20yy:

• Graduated between July 1 and Sept. 1

• Graduate Doctorate

• Graduate Master’s

• Graduate Other

• Undergraduate Senior

• Undergraduate Junior

• Undergraduate Sophomore

• Undergraduate Freshman

• Undergraduate Other

Area of Study: (Select one)

• Agricultural Sciences

• 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

If the student received a degree during the current reporting period, enter the degree received, area of study, and (for students receiving a master’s degree or Ph.D.) title of the thesis or dissertation.

Degree Received: (Select one):

• Bachelor’s

• Master’s

• Ph.D.

Title of Thesis or Dissertation

Which of the following kinds of financial support did the student receive through the CREST center/HBCU-RISE award during the current reporting period? (Mark one or more):

• Tuition

• Stipend

• Other (Please specify): __________

Financial Support Source: (Select one)

• NSF CREST/HBCU-RISE program

• Other (Please specify): __________

Indicate the number of academic terms of support received through the CREST center/HBCU-RISE award during the current reporting period, by type of support:

• Tuition

• Stipend

• Other

What was the student’s status at the end of the current reporting period? (Mark one or more)

• 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) __________

Other Personnel

Name (First Name, Middle Name, Last Name)

Cited-Only Information

Is this person a former participant who is listed only because he or she is cited on a proposal, award, presentation, collaborative project, patent, activity, and/or conference that is listed for the current reporting period?

• 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, Country)

Phone

Fax

E-mail Address

Mark this checkbox if 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).

Demographic Information

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 Status: (Select one)

• Yes (Select 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

• Permanent Resident

• Other Non-U.S. Citizen

• U. S. Citizen

Thrust Areas

Mark one or more thrust areas in which this participant participated during the current reporting period:

• Education and Outreach

• Thrust Area 1

• Thrust Area 2

• …

• N/A

Contributor

Name (First Name, Middle Name, Last Name)

Contact Information:

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

4. Accomplishments

Proposals/Awards

Status

• Proposal

• Award

Title

Thrust Area: (Select one)

• Education and Outreach

• Thrust Area 1

• Thrust Area 2

• …

Funding Source Type: (Select one)

• Federal

• State

• University

• Industry

• Foundation

• Other

Funding Source Name

Was this an NSF funding source? (Select one)

• Yes

• No

Type of Award: (Select one)

• Research

• Education

• 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/HBCU-RSE Contributed to This Accomplishment

Presentations

Presentation Title

Thrust Area (Select one)

• Education and Outreach

• Thrust 1

• Thrust 2

• …

Presentation Location

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

OR

Conference Name

Conference Location (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/HBCU-RISE Contributed to This Presentation

Publications

Publication Title

Thrust Area (Select one)

• Education and Outreach

• Thrust Area 1

• Thrust Area 2

• …

Publication Name

Publication Type: (Select one)

• Book chapter or textbook

• Article in refereed journal

• Article in public proceedings

Status of Publication: (Select one)

• Accepted, Awaiting Publication

• Other (Please specify): __________

• Published (Volume, Year)

• Submitted, Under Review

Citation:

Page Number

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/HBCU-RISE Contributed to This Publication

Collaborative Projects

Collaborative Project Title

Thrust Area (Select one)

• Education and Outreach

• 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/HBCU-RISE Contributed to This Collaborative Project

Collaborative Partner(s):

Institution 1 (Name, Type, City, State/Region, Country)

Funding Source: (Mark one or more)

• Federal

• State

• University

• Industry

• Other (Please specify): __________

NSF Programs Related to This Partner: (Mark one or more)

(for institution type=University only)

NSF intends to revise the list of programs about which respondents are prompted to provide information as indicated in the table below.

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? (Select one)

• Yes

• No

Research for graduates? (Select one)

• Yes

• No

Research for postdocs? (Select one)

• Yes

• No

Is this collaboration international? (Select one)

• 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 period

Patents

Patent Title

Thrust Area: (Select one)

• Education and Outreach

• 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/HBCU-RISE Contributed to This Patent

Activities

Activity Title

Thrust Area: (Select one)

• Education and Outreach

• 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

• Safety activities

Activity Start Date

Activity End Date

Institutions Involved:

Institution 1 (Name, Type, City, State/Region, Country)

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

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

Description of How CREST/HBCU-RISE Contributed to This Activity

Conferences Organized

Conference Title

Conference Topic

Thrust Area: (Select one)

• Education and Outreach

• Thrust Area 1

• Thrust Area 2

• …

Conference Start Date

Conference End Date

Conference Location:

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

OR

Conference Location (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/HBCU-RISE Contributed to This Conference

5. Functional Budget

Budget data by source of support and functional area:

Funds Allocated to	Source
	NSF CREST	Other NSF	Other Federal Government	State	Local Government	Industry	University	Other	Total
Education and Outreach
Thrust 1
Thrust 2
…
CREST/HBCU-RISE 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, and 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.