Participant Contact Information

Attachment 8e:

Form to Collect Potential Participant Contact Information from PIs

Noyce PI Evaluation Referral Form

Start of Block: Noyce PI Evaluation Referral Form

Introduction: This form will provide us with the contact information for individuals involved with your Noyce project so that we may contact them to understand their perceptions and perspectives on the Noyce Program.

We request that the individuals you refer are involved with your current or most recent Noyce project, including program coordinators/program support staff, external evaluators, faculty mentors/supervisors, current/former Noyce scholars/fellows, and any K-12 high-need school or district partners. Please provide as many contacts and as much contact information as you can. We recognize that not every Noyce project has all of these individuals or roles, and answers can be left blank for individuals who are not a part of your Noyce project.

For additional information or questions related to the Noyce Program evaluation, please contact WhitworthKee Consulting at [email protected] or (202) 339-1473 ext. 2009. We appreciate your help in making the evaluation a success.

End of Block: Noyce PI Evaluation Referral Form

Start of Block: Program Coordinator/Support Staff

Please list the name and email address of your Noyce program coordinator or program support staff (if applicable).

Q2 Program Coordinator/Support Staff #1:

First name __________________________________________________

Last name __________________________________________________

Email address __________________________________________________

Q3 Program Coordinator/Support Staff #2:

First name __________________________________________________

Last name __________________________________________________

Email address __________________________________________________

End of Block: Program Coordinator/Support Staff

Start of Block: External Evaluator

Please list the name and email address of your Noyce project's external evaluator.

Q5 External Evaluator

First name __________________________________________________

Last name __________________________________________________

Email address __________________________________________________

End of Block: External Evaluator

Start of Block: Faculty

Please list the name and email address of any faculty mentors or student supervisors affiliated with your Noyce project.

Q7 Faculty #1

First name __________________________________________________

Last name __________________________________________________

Email address __________________________________________________

Q8 Faculty #2

First name __________________________________________________

Last name __________________________________________________

Email address __________________________________________________

Q9 Faculty #3

First name __________________________________________________

Last name __________________________________________________

Email address __________________________________________________

End of Block: Faculty

Start of Block: K-12 Leaders

Please list the name and email address of any K-12 high-need district or school leaders affiliated with your Noyce project.

Q11 K-12 leader #1

First name __________________________________________________

Last name __________________________________________________

Email address __________________________________________________

Q12 K-12 leader #2

First name __________________________________________________

Last name __________________________________________________

Email address __________________________________________________

Q13 K-12 leader #3

First name __________________________________________________

Last name __________________________________________________

Email address __________________________________________________

Q14 K-12 leader #4

First name __________________________________________________

Last name __________________________________________________

Email address __________________________________________________

End of Block: K-12 Leaders

Start of Block: Miscellaneous

Please use these spaces to list the name and email address of any additional referrals affiliated with your Noyce project.

Q16 Person #1

Role __________________________________________________

First name __________________________________________________

Last name __________________________________________________

Email address __________________________________________________

Q17 Person #2

Role __________________________________________________

First name __________________________________________________

Last name __________________________________________________

Email address __________________________________________________

Q18 Person #3

Role __________________________________________________

First name __________________________________________________

Last name __________________________________________________

Email address __________________________________________________

End of Block: Miscellaneous