Application Form
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Contact Information
(All information will be confidential)

(Please be sure to enter all applicable information below carefully)

Name

Title

Company/Organization

Location (City/State/Zip/Country)

Phone Number

Email Address

Basic Information

What is the name of this project or accomplishment?

Briefly describe the project/accomplishment/innovation:

Did this accomplishment generate financial ROI or Innovation or both?
SELECT ONE FROM DROP DOWN Financial ROI Innovation Both

For Projects that Created a Financial ROI

What are (or is expected to be) THE FINANCIAL RETURNS from this project/program/discovery:

What are (or will be) the TOTAL REVENUES?
SELECT ONE FROM DROP DOWN $1 to $100,000 $100,001 to $250,000 250,001 to $500,000 $500,001 to $750,000 $750,001 to $999,999 $1 million to $2.5 million $2.5 million to $5 million $5 million to $7.5 million $7.5 to $10 million $10 to $25 million $25 to $50 million $50 to $85 million $75 to $100 million $100 to $250 million $250 to $500 million $500 to $750 million $750 to $999 million $1 to $2.5 billion $2.5 to $5 billion $5 to $7.5 billion $7.5 to $10 billion $10 to $25 billion $25 to $50 billion $50 to $75 billion $75 to $99 billion Over $100 billion

What are (or will be) the TOTAL PROFITS or COST SAVINGS?
SELECT ONE FROM DROP DOWN $1 to $100,000 $100,001 to $250,000 250,001 to $500,000 $500,001 to $750,000 $750,001 to $999,999 $1 million to $2.5 million $2.5 million to $5 million $5 million to $7.5 million $7.5 to $10 million $10 to $25 million $25 to $50 million $50 to $85 million $75 to $100 million $100 to $250 million $250 to $500 million $500 to $750 million $750 to $999 million $1 to $2.5 billion $2.5 to $5 billion $5 to $7.5 billion $7.5 to $10 billion $10 to $25 billion $25 to $50 billion $50 to $75 billion $75 to $99 billion Over $100 billion

If this project/program/discovery CREATED NEW JOBS, about how many full-time equivalent jobs where created?
(number of jobs created or saved)

How many years from the start of research was it before the first returns started? (Years)
(Years)

For Projects that Created an Innovation

What was general category of the innovation?
PLEASE SELECT ONE FROM DROPDOWN Basic Research (including major discoveries and pioneering breakthroughs) Applied Research (including incremental innovations and process improvements )


How would you rate this innovation compared to all other innovations in this field over the last ten years, using a scale of 1 to 10:
PLEASE SELECT ONE FROM DROPDOWN (With 10 Being the Highest) 10 (One of the top 2 to 3 innovations in the last decade ) 9 (One of the top 5 innovations in the last decade) 8 (One of the top 10 innovations in the last decade) 7 (One of the top 25 innovations in the last decade) 6 (One of the top 50 innovations in the last decade) 5 (An innovation that had a major impact and is useful to many organizations) 4 (A minor innovation that is useful to many organizations) 3 (A minor innovation or only useful to 2 -3 organizations) 2 (A minor innovation or only useful to 1 organization) 1 (An important innovation that is recognized ONLY by experts in the field)

If this innovation created new jobs, approximately how many full-time equivalent jobs were created:

Investments Required

HPC INVESTMENTS

What was the total HPC Investment for the project?
(Note: only count or estimate the portion that was used for this project, and specifically for HPC resources — include only the direct system costs, e.g. hardware, software, applications, interconnects, and storage used to accomplish this achievement — If you used external HPC system resources, please include only the direct costs that you paid or the estimated value in order to accomplish this achievement).
SELECT ONE FROM DROP DOWN $1 to $100,000 $100,001 to $250,000 250,001 to $500,000 $500,001 to $750,000 $750,001 to $999,999 $1 million to $2.5 million $2.5 million to $5 million $5 million to $7.5 million $7.5 to $10 million $10 to $25 million $25 to $50 million $50 to $85 million $75 to $100 million $100 to $250 million $250 to $500 million $500 to $750 million $750 to $999 million $1 to $2.5 billion $2.5 to $5 billion $5 to $7.5 billion $7.5 to $10 billion $10 to $25 billion $25 to $50 billion $50 to $75 billion $75 to $99 billion Over $100 billion

TOTAL R&D INVESTMENTS

What was the total research/development/engineering investment for the project:
(Please include all of the R&D costs like equipment, people/staff, instruments, buildings, HPC systems, power, etc.)
SELECT ONE FROM DROP DOWN $1 to $100,000 $100,001 to $250,000 250,001 to $500,000 $500,001 to $750,000 $750,001 to $999,999 $1 million to $2.5 million $2.5 million to $5 million $5 million to $7.5 million $7.5 to $10 million $10 to $25 million $25 to $50 million $50 to $85 million $75 to $100 million $100 to $250 million $250 to $500 million $500 to $750 million $750 to $999 million $1 to $2.5 billion $2.5 to $5 billion $5 to $7.5 billion $7.5 to $10 billion $10 to $25 billion $25 to $50 billion $50 to $75 billion $75 to $99 billion Over $100 billion


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