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2024 CUTC Technology
Transfer Leadership Award
Please make sure your responses entered in this form address the evaluation criteria clearly. A copy of the evaluation criteria can be found at on the
CUTC Leadership Awards page
under
CUTC Technology Transfer Leadership Award
and click on "award requirements".
Nominator:
First Name
*
Last Name
*
Address
*
Address Line 2
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
Phone Number
*
Email Address
*
Relation to Institution Nominated:
*
Name of Institution Nominated:
*
Name of Contact at Institution Nominated:
Nominee (Contact) Address:
Address
*
Address Line 2
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
Nominee Phone Number
*
Nominee Email Address
*
Salutation
Describe the program and its design.
*
Describe the new collaborative partnerships that have been developed.
*
Describe the scalability and transferability of the program.
*
3 Supporting Documents
that may include two (2) letters of support and any additional information.
First Letter of Support
*
Second Letter of Support
*
Additional Information
The maximum file size for any upload is 10 MB.