2016-2017 ORTOP TEAM SUPPORT AWARD APPLICATION for FIRST TECH CHALLENGE
Applicant Contact Information and Demographics
Complete the application for one team inFIRST Tech Challenge after reviewing the ORTOP Team
Support information page.
2016-2017 ORTOP Team Support Award is administered by the Oregon Robotics Tournament and
Outreach Program and funded by numerous ORTOP sponsors including Intel, Rockwell Collins,
Google, Garmin, MJ Murdock Charitable Trust and others.
* 1. Name of the applicant completing this application
Name:
Email Address:
Phone Number:
* 2. Check the box(es) that best describe the role(s) of the person completing the application
Teacher
Parent of a team member
Coach or Mentor for the team
Non-parent volunteer for the team
School administrator
School or School District Grant Writer
Other (please specify)
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* 3. Applicant, School or Organization Contact Information
School/Organization (if
applicable):
School District (if
applicable):
Mailing Address:
Address 2:
City/Town:
State:
-- select state --
ZIP:
COUNTY (not country):
* 4. ORTOP Team Support Award recipients are limited to teams in the states of Oregon and Washington
(Skamania/Klickatat counties). What best describes your team's affiliation?
Public School
Public Charter School
Private School
directly managed by a non-profit organization as an after-school or weekend program
not affiliated with an organization or school; such as neighborhood team
non-profit organization affiliated club/troop not directly managed by non-profit organization
Homeschool team
Other (please specify)
* 5. Using the links to demographic information available on the application information page.
Please provide the percentage of students at your school who receive free or reduced lunch. If your team
members do not attend public school, please provide the free and reduced lunch percentage for the public
school they are zoned to attend.
Name of referenced
school/district
Percentage of Free at
Reduced Lunch at
referenced public school
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* 6. Workers in industry who identify as Black, Latino/Hispanic or Native Americans are currently
underrepresented in jobs requiring high-tech skills and STEM-related college degrees. Please describe
your strategy to be inclusive of Black, Latino/Hispanic or Native Americans students on your team as well
as any challenges in doing so.
* 7. For which type of award are you choosing to apply? (Select one per application)
FIRST Tech Challenge - ROOKIE TEAM (7th - 12th Grade)
FIRST Tech Challenge - VETERAN TEAM (7th - 12th Grade)
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2016-2017 ORTOP TEAM SUPPORT AWARD APPLICATION for FIRST TECH CHALLENGE
FIRST Tech Challenge - VETERAN TEAM Application
FIRST Tech Challenge Veteran Team - some or all students on team have previously participated in
FIRST Tech Challenge prior to the 2016-2017 season. Team, school or organization owns a
Tetrix/Matrix kit and FTC Control System Electronics (new in 2015/16) for the team to use. Has an
FTC Team # from the previous season
Question responses should be limited to 200 words except where specified.
* 20. Every FIRST Tech Challenge team must have two adult coaches.
For the 2016-2017 FIRST Season list those individuals with their contact information. If coaches are
unknown at time of application, enter "unknown" in boxes. (This information must be submitted prior to
funds being dispersed)
Coach #1 - Name
Coach #1 - Email address
Coach #2 - Name
Coach #2 - Email Address
* 21. How many FIRST Tech Challenge Teams that were national registered in the 2015-2016 FTC season
were considered directly associated with the applicant, school or organization?
* 22. Please provide all FIRST Tech Challenge team numbers directly associated with your team, school or
organization in the 2015-2016 FTC sesaon
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* 23. As a veteran FIRST Tech Challenge team, please share your team's strategy for improving upon last
year's build season prior to the competition. Please focus on your meeting space, schedule and
preparations to be a successful team (not awards goals). Please address challenges faced by the team last
season and how they might be overcome.
* 24. Although it is possible to build an FTC robot from just the kit of parts, to be competitive most teams add
fabricated parts to their robot to be more competitive. Please describe your team's access to common DoIt-Yourself tools (table saw, hand drill, heat gun, vice/clamps, 3D printer, bansaw, etc. or machine shop
tools (CNC machine, laser cutter, etc.).
Successful companies strive for a diverse workforce to create an innovative and productive work environment. A diverse FIRST Tech
Challenge team would be inclusive of people from both genders, minority students, ESL students and students with disabilities.
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* 25. Diversity Recruitment Strategy
Describe a general strategy you would use for recruiting students to your team who might not consider
participating on a FIRST Tech Challenge robotics team as first choice or something that they can see
themselves doing.
* 26. At the FIRST World Championship in 2016, FIRST teams were challenged to be more inclusive of
young women on teams and encourage those young women to contribute in many aspects of the team
activities. One challenge mentors sometimes face is encouraging young women to try all aspects of the
program; robot design, build, programming,the engineering notebook, competitive analysis, marketing,
project management and outreach. Please describe a strategy to encourage young women to be involved
in both technical and non-technical aspects of the challenge.
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* 27. What is your plan for inviting and engaging mentors who will participate in the FIRST Tech Challenge
program? Please describe your successes and challenges in securing mentors. List returning and possible
new mentors, their roles and affiliations for the 2016-2017 season.
* 28. In the post-season how would you share with community your team's season experience?
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* 29. Provide a summarized financial plan for your FIRST Tech Challenge team which covers the items in the
sample budget but is specific to your team's needs. Your financial plan needs to Include the portion of the
team budget that can be covered by team dues,
fund raisers, support of organizations like PTO or PTA, other local businesses, grants from the Oregon
Department of Education, or other sources .
If items are donated or borrowed, enter "in-kind donation."
If items are owned by the team and do not need to be purchased, enter "owned by team".
Team Dues
Fundraisers
Local Support - PTO,
businesses
Grants/Awards
Other Income
INCOME TOTAL
Comments on Income
Meeting space fees, if any
Registration/Event Fees
Robot Kit/Spare Parts
Laptop
FTC Field
components/annual game
elements
Tools
Materials for fabricating
parts
Travel costs
Other Expenses
EXPENSES TOTAL
Comments on Expenses
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* 30. Please tell us the reasons why your team is requesting financial assistance.
Focus on the financial challenges faced by your team.
31. Any final comments?
Thank you for your responses. Please click submit at the bottom of the page to finalize your answers. Be sure to send us a W-9 form for
your organization, school or as an individual if unaffiliated.
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2016-2017 ORTOP TEAM SUPPORT AWARD APPLICATION for FIRST TECH CHALLENGE
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