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    If any, please list:

    Description Category Type New/Existing

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    Participants Direct Interaction Indirect Interaction
    Pre-Service Teachers
    Higher Education Faculty
    Undergraduate
    Graduate
    Post Doctoral
    Community College
    Total Participants

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    Name email Institution Gender Level
    Race Disability
    Name email Institution Gender Level
    Race Disability
    Name email Institution Gender Level
    Race Disability
    Name email Institution Gender Level
    Race Disability
    Name email Institution Gender Level
    Race Disability

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    PI Name Funding Entity Number of Grants Submitted Number of Grants with Determination Number of Grants Awarded Value of Grants with Awarded

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    New Course Name New Course Number Institution/Department Number of Indirect Participants (students in the class)

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    Revised Course Name Revised Course Number Institution/Department Number of Indirect Participants (students in the class)

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    Author Year Title Publication Peer Reviewed? Author Category

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    Author Year Title Publication Peer Reviewed? Author Category

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    Title Presenter Venue

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    Title Presenter Venue

    Title Institution Name of Funding Organization Type of funding: Private, Federal, State, Industry, etc Amount Requested Amount Received

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    How many patents, based on research/activities associated with this activity, have been granted? (If zero, enter 0)
    Please list granted patent(s)

    Patent Date Received

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    How many patent licenses, based on research/activities associated with this activity, have been issued?(If zero, enter 0)
    Otherwise please list:

    License Date Issued

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    How many technology transfer activities have resulted from research/activities associated with this activity? (If zero, enter 0)
    Otherwise please list:

    Activity Transfer Partner

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