NASA ISGC Project Collaborator Information Form

Thank you for contributing to a NASA Idaho Space Grant Consortium (NASA ISGC) Project!

NASA requires that individuals participating in NASA ISGC-funded projects provide demographic information that NASA can use to track participants and the effectiveness of the program. The information will be forwarded to NASA for tracking purposes. You may receive periodic emails from NASA to update your contact information.

Last Name

First Name

Middle initial

Project Type

Higher Education

K-12/Informal Education

Job title

Project Title

Date of birth

mm/dd/yyyy

Work address (number and street)

Work address (city)

Work address (Zip code)

Work phone number

Alternate phone number

Work email address

Alternate email address

LinkedIn address

Website

Citizenship

U.S. Citizen

U.S. Permanent Resident

Other (please specify)

Other citizenship

Gender

Other Gender

Disability

Other disability

Have you ever served in the U.S. Armed Forces?

Race

For more information about this question, please visit: https://www.census.gov/mso/www/training/pdf/race-ethnicity-onepager.pdf

Other Race

Ethnicity

Other Ethnicity

Have you ever participated in any NASA or NASA ISGC activities prior to this project? If so, please describe them here.

Form certification

By checking the box below, you certify that the information you provide in this form is complete and accurate.

Release of information to public and congressional representatives

By checking the box below, you authorize NASA ISGC and its affiliates to share information about you and your project with the public and Idaho's congressional representatives.

Release of information to NASA

By checking the box below, you authorize NASA ISGC to share detailed information about you (e.g., demographic information) with NASA as needed.

Other comments?

Is there anything else you want to tell us?

NASA Media Release

In the event that NASA likes your project and wants to share your story with the public, they need your permission to do so. Please fill out and sign the form located at https://www.idahospacegrant.org/_files/ugd/0fc144_0fb66371103045f3912916da255d1884.pdf and upload it here.

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