Possible Project Partners Form

Organization Information

Organization Name:

Organization Phone Number:

Organization Address:

Contact Information

Name:

Phone Number:

Email:

Example: username@host.com

Address (if different):

Type of Organization:

Location:

Mission:

Population(s) served by your organization:

As we continue to grow and add teams, we need more qualified advisors for the teams. We can not always meet this requirement with Purdue faculty and staff and have been successful integrating advisors from industry. If you know of someone who could assist with advising it would be a great help. Availability of qualified advisors is a factor in our decision to start a team.

List someone in your organization that can advise the EPICS team if any:

To begin our discussion, please describe your initial ideas for projects. We realize that these are only initial ideas and the team will work with you to refine and develop these projects. Ideally, we like to start with a unit of short and long term projects.

Describe ideas for potential projects:

We start new teams each semester. Planning for the Spring Semester, which starts in January, occurs in late August. Planning for the Fall Semester, which starts in August, happens in mid-January.

Desired starting date for EPICS team: