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Awardee First Name
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Awardee Last Name
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Organization
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Award Number
This number is located on your award letter (i.e. RIP(YR)_X.X)
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Faculty/Research Participant Information
List Name, Institute Name and Department for each tenure/non-tenure faculty/researcher participant, research assistant, staff (Include Awardee Information)
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List all organizations associated with your program
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List the city, state and zip code for each location where the activity was conducted.
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NASA Connections
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Was this activity held at a NASA Center, select all that apply:
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Was there a partnership with a NASA Center on this project?
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