Supplement COVER SHEET FOR PROPOSAL TO THE NATIONAL SCIENCE FOUNDATIO N

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1 Supplement COVER SHEET FOR PROPOSAL TO THE NATIONAL SCIENCE FOUNDATIO N PROGRAM ANNOUNCEMENT/SOLICITATION NO./CLOSING DATE/it not in response to a program announcement/solicitation enter NSF FOR CONSIDERATION BY NSF ORGANIZATION UNIT(S) (Indicate the most specific unit known, I.e. program, division, etc.) NSF PROPOSAL NUMBER REC - PROGRAM EVALUATIO N DATE RECEIVED NUMBER OF COPIES DIVISION ASSIGNED FUND CODE DUNS# (Data Universal Numberingsystem) FILE LOCATIO N EMPLOYER IDENTIFICATION NUMBER (EIN) O R TAXPAYER IDENTIFICATION NUMBER (TIN) SHOW PREVIOUS AWARD NO, IF THIS I S A RENEWAL AN ACCOMPLISHMENT-BASED RENEWA L NAME OF ORGANIZATION TO WHICH AWARD SHOULD BE MADE Cornell University - State AWARDEE ORGANIZATION CODE (IF KNOWN) NAME OF PERFORMING ORGANIZATION, IF DIFFERENT FROM ABOVE IS THIS PROPOSAL BEING SUBMITTED TO ANOTHER FEDERA L AGENCY? YES NO IF YES, LIST ACRONYM(S ) ADDRESS OF AWARDEE ORGANIZATION, INCLUDING 9 DIGIT ZIP COD E Cornell University - Stat e S p onsored Pro grams Service s Ithaca, NY ADDRESS OF PERFORMING ORGANIZATION, IF DIFFERENT, INCLUDING 9 DIGIT ZIP COD E PERFORMING ORGANIZATION CODE (IF KNOWN ) IS AWARDEE ORGANIZATION (Check All That Apply) SMALL BUSINESS MINORITY BUSINES S (See GPG II.0 For Definitions) FOR-PROFIT ORGANIZATION WOMAN-OWNED BUSINESS TITLE OF PROPOSED PROJECT REUESTED AMOUN T $ 33,000 Building Evaluation System Capacity for STEM Programs : Enhancin g Capability and Advancing Practic e PROPOSED DURATION (1-60 MONTHS) 0 months CHECK APPROPRIATE BOX(ES) IF THIS PROPOSAL INCLUDES ANY OF THE ITEMS LISTED BELOW BEGINNING INVESTIGATOR (GPG I.A) HUMAN SUBJECTS (GP G II.D.6) DISCLOSURE OF LOBBYING ACTIVITIES (GPG II.C) Exemption Subsectio n PROPRIETARY & PRIVILEGED INFORMATION (GPG I.B, II.C.1.d ) HISTORIC PLACES (GPG II.C.2.j) SMALL GRANT FOR EXPLOR. RESEARCH (SGER) (GPG II.D.1) VERTEBRATE ANIMALS (GPG 11.D.5) IACUC App. Date PI/PD DEPARTMENT Policy Analysis & Management Dept. PI/PD FA 607 X FAX NUMBE R PI/PD POSTAL ADDRES S 249 MVR Cornell University Ithaca, NY United States IF THIS IS A PRELIMINARY PROPOSA L THEN CHECK HER E REUESTED STARTING DATE SHOW RELATED PRELIMINARY PROPOSAL NO. IF APPLICABL E INTERNATIONAL COOPERATIV E (GPG II.C.2.j) or IRB App. Date ACTIVITIES : COUNTRY/COUNTRIES INVOLVED HIGH RESOLUTION GRAPHICS/OTHER GRAPHICS WHERE EXACT COLO R REPRESENTATION I S REUIRED FOR PROPER INTERPRETATION (GPG I.G.1 ) NAMES (TYPED) High Degree Yr of Degree Telephone Number Electronic Mail Addres s PI/PD NAME CO-PI/PD PhD w mtl@cornell.edu CO-PI/P D CO-PI/P D CO-PI/PD Page 1 of 2

2 CERTIFICATION PAG E Certification for Authorized Organizational Representative or Individual Applicant : By signing and submitting this proposal, the individual applicant or the authorized official of the applicant institution is : (1) certifying that statements made herein are true and complete to the best of his/her knowledge ; and (2) agreeing to accept the obligation to comply with NS F award terms and conditions if an award is made as a result of this application. Further, the applicant is hereby providing certification s regarding debarment and suspension, drug-free workplace, and lobbying activities (see below), as set forth in Gran t Proposal Guide (GPG), NSF Willful provision of false information in this application and its supporting documents or in reports required under an ensuing award is a criminal offense (U. S. Code, Title 18, Section 1001). In addition, if the applicant institution employs more than fifty persons, the authorized official of the applicant institution is certifying that the institution ha s implemented a written and enforced conflict of interest policy that is consistent with the provisions of Grant Policy Manual Section 510 ; that to the best of his/her knowledge, all financial disclosures required by that conflict of interest policy have been made ; and that all identified conflicts of interest will hav e been satisfactorily managed, reduced or eliminated prior to the institution's expenditure of any funds under the award, in accordance with th e institution's conflict of interest policy. Conflicts which cannot be satisfactorily managed, reduced or eliminated must be disclosed to NSF. Drug Free Work Place Certification By electronically signing the NSF Proposal Cover Sheet, the Authorized Organizational Representative or Individual Applicant is providing the Drug Free Work Place Certificatio n contained in Appendix C of the Grant Proposal Guide. Debarment and Suspension Certification (If answer "yes", please provide explanation.) Is the organization or its principals presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily exclude d from covered transactions by any Federal department or agency? Yes No By electronically signing the NSF Proposal Cover Sheet, the Authorized Organizational Representative or Individual Applicant is providing the Debarment and Suspension Certificatio contained in Appendix D of the Grant Proposal Guide. Certification Regarding Lobbyin g This certification is required for an award of a Federal contract, grant, or cooperative agreement exceeding $100,000 and for an award of a Federal loan o r a commitment providing for the United States to insure or guarantee a loan exceeding $150,000. Certification for Contracts, Grants, Loans and. Cooperative Agreements The undersigned certifies, to the best of his or her knowledge and belief, that : (1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influenc e an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connectio n with the awarding of any federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer o r employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with thi s Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbyin g Activities," in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers includin g subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any person who fails to file th e required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. n AUTHORIZED ORGANIZATIONAL REPRESENTATIVE SIGNATURE DAT E NAM E TELEPHONE NUMBER ELECTRONIC MAIL ADDRESS FAX NUMBE R *SUBMISSION OF SOCIAL SECURITY NUMBERS IS VOLUNTARY AND WILL NOT AFFECT THE ORGANIZATION'S ELIGIBILITY FOR AN AWARD. HOWEVER, THEY ARE A N INTEGRAL PART OF THE INFORMATION SYSTEM AND ASSIST IN PROCESSING THE PROPOSAL. SSN SOLICITED UNDER NSF ACT OF 1950, AS AMENDED. Page 2 of 2

3 SUMMARY OF PROPOSED WOR K Funding for two undergraduate students is requested as a supplemental grant to existin g NSF reward # Two students, Sabrina Rahman and Anna Hays, have been pre-selecte d for these positions (see biographical sketches in supplemental documents). Both research assistants will primarily be responsible for assisting with tasks related to th e development of both a Theory of Systems Evaluation and the corresponding protoco l described fully in the "Building Evaluation Systems Capacity for STEM Programs" projec t funded in October In particular, the research assistants will be expected t o conduct library research and literature reviews, assist in the identification and/o r development of indicator variables and measures of outcomes, keep comprehensive an d accurate records for the project, and assist in the production of reports and papers.

4 JUSTIFICATION FOR SUPPLEMENTAL FUNDING. Ms. Rahman and Ms. Hays have a history of working with the project's Principa l Investigator (Bill Trochim) and research team on this important evaluation project. Furthermore, both the PI and the members of the research team share a commitment to engage undergraduates in research projects related to a variety of programmatic areas includin g systems evaluation. In particular, both Ms. Rahman and Ms. Hays have successfully completed similar work in relation to a project aimed at improving the evaluation capacit y and evaluation systems in extension and outreach throughout New York State. Thes e research assistants have already completed extensive literature reviews and assisted with composing reports related to a variety of program areas including health and nutrition, family and youth development, community development, and STEM education. Finally, please note that both Ms. Rahman and Ms. Hays were selected from a large pool of applicants interested in this research opportunity because they both expressed a particular interest in evaluation, have experience in conducting extensive literatur e reviews, and have strong academic records.

5 SUMMARY YEAR 1 PROPOSAL BUDGET ORGANIZATION PROPOSAL NO. DURATION (months ) Cornell University - State Proposed Grante d PRINCIPAL INVESTIGATOR / PROJECT DIRECTOR AWARD NO. William M Trochi m A. SENIOR PERSONNEL: PI/PD, Co-PI's, Faculty and Other Senior Associates ( List each se Paratel Y with title, A.7. show number in bracket s) =ésônmônlhs CAL ACAD SUM R Fund s R equeste d B y proposer 1. - none $ 0 $ ( 0 ) OTHERS (LIST INDIVIDUALLY ON BUDGET JUSTIFICATION PAGE) ( 1 ) TOTAL SENIOR PERSONNEL (1-6) B. OTHER PERSONNEL (SHOW NUMBERS IN BRACKETS ) 1. ( 0) POST DOCTORAL ASSOCIATES ( 0 ) OTHER PROFESSIONALS (TECHNICIAN, PROGRAMMER, ETC.) ( 0) GRADUATE STUDENTS 0 4.( 0) UNDERGRADUATE STUDENTS 0 5. ( 0 ) SECRETARIAL - CLERICAL (IF CHARGED DIRECTLY) 0 6. ( 0) OTHER 0 TOTAL SALARIES AND WAGES (A + B) 0 C. FRINGE BENEFITS (IF CHARGED AS DIRECT COSTS) 0 _ TOTAL SALARIES, WAGES AND FRINGE BENEFITS (A + B + C) D. EUIPMENT (LIST ITEM AND DOLLAR AMOUNT FOR EACH ITEM EXCEEDING $5,000. ) Fund s gran t e d b y NS F (if different ) TOTAL EUIPMENT 0 E. TRAVEL 1. DOMESTIC (INCL. CANADA, MEXICO AND U.S. POSSESSIONS) 0 2. FOREIGN F. PARTICIPANT SUPPORT COST S 1. STIPENDS $ 20, TRAVEL SUBSISTENCE 0 4. OTHER TOTAL NUMBER OF PARTICIPANTS ( 2) TOTAL PARTICIPANT COSTS 20, D O G. OTHER DIRECT COSTS 1. MATERIALS AND SUPPLIES 0 2. PUBLICATION COSTS/DOCUMENTATION/DISSEMINATION 0 3. CONSULTANT SERVICES 4. COMPUTER SERVICES 0 5. SUBAWARDS 0 6. OTHER 0 TOTAL OTHER DIRECT COSTS 0 H. TOTAL DIRECT COSTS (A THROUGH G) I. INDIRECT. COSTS (F&A)(SPECIFY RATE AND BASE ) administrative allowance (Rate : , Base : 20800) TOTAL INDIRECT COSTS (F&A ) 5,20 0 J. TOTAL DIRECT AND INDIRECT COSTS (H + I) 26,00 0 K. RESIDUAL FUNDS (IF FOR FURTHER SUPPORT OF CURRENT PROJECTS SEE GPG II.C.6.j.) 0 L. AMOUNT OF THIS REUEST (J) OR (J MINUS K) $ 26,000 $ M. COST SHARING PROPOSED LEVEL $ 0 AGREED LEVEL IF DIFFERENT $ PI/PD NAM E INDIRECT COST RATE VERIFICATIO N ORG. REP. NAME* Date Checked Date OF Rate Sheet Initials - ORG I i 1 *ELECTRONIC SIGNATURES REUIRED FOR REVISED BUDGE T

6 MARY YEAR 2 PROPOSAL BUDGET ORGANIZATIO N PROPOSAL NO. DURATION (months ) Cornell University - State Proposed Granted PRINCIPAL INVESTIGATOR / PROJECT DIRECTO R AWARD NO. d A. SENIOR PERSONNEL: PI/PD, Co-PI's, Faculty and Other Senior Associates Funds, P s Funds Requeste d B y grante d by N S F ( List each se ParatelY with title, A.7. show number in brackets ) CAL ACAD SUM R proposer (if different ) 1. - none $ 0 $ ( 0) OTHERS (LIST INDIVIDUALLY ON BUDGET JUSTIFICATION PAGE) ( 1) TOTAL SENIOR PERSONNEL (1-6) B. OTHER PERSONNEL (SHOW NUMBERS IN BRACKETS ) 1. ( 0) POST DOCTORAL ASSOCIATES ( 0) OTHER PROFESSIONALS (TECHNICIAN, PROGRAMMER, ETC.) ( 0) GRADUATE STUDENTS 0 4.( 0) UNDERGRADUATE STUDENTS 0 5. ( 0) SECRETARIAL - CLERICAL (IF CHARGED DIRECTLY) 0 6.( 0)OTHER 0 TOTAL SALARIES AND WAGES (A + B) 0 C. FRINGE BENEFITS (IF CHARGED AS DIRECT COSTS) 0 _ TOTAL SALARIES, WAGES AND FRINGE BENEFITS (A + B + C) 0_ D. EUIPMENT (LIST ITEM AND DOLLAR AMOUNT FOR EACH ITEM EXCEEDING $5,000. ) TOTAL EUIPMENT 0 E. TRAVEL 1. DOMESTIC (INCL. CANADA, MEXICO AND U.S. POSSESSIONS) 0 2. FOREIGN 0 F. PARTICIPANT SUPPORT COSTS 1. STIPENDS $ 5, TRAVEL SUBSISTENCE 0 4. OTHER TOTAL NUMBER OF PARTICIPANTS ( 2) TOTAL PARTICIPANT COSTS 5,60 0 G. OTHER DIRECT COSTS 1. MATERIALS AND SUPPLIES 0 2. PUBLICATION COSTS/DOCUMENTATION/DISSEMINATION 0 3. CONSULTANT SERVICES 0 4. COMPUTER SERVICES 0 5.5UBAWARD OTHER 0 TOTAL OTHER DIRECT COSTS 0 H. TOTAL DIRECT COSTS (A THROUGH G) 5 _,600 I. INDIRECT COSTS (F&A)(SPECIFY RATE AND BASE ) administrative allowance (Rate : , Base : 5600) TOTAL INDIRECT COSTS (F&A ) 1,400 J. TOTAL DIRECT AND INDIRECT COSTS (H + I) 7,000 K. RESIDUAL FUNDS (IF FOR FURTHER SUPPORT OF CURRENT PROJECTS SEE GPG II.C.6.j.) 0 L. AMOUNT OF THIS REUEST (J) OR (J MINUS K) $ 7,000 $ M. COST SHARING PROPOSED LEVEL $ 0 AGREED LEVEL IF DIFFERENT $ PI/PD NAME INDIRECT COST RATE VERIFICATION ORG. REP. NAME* Date Checked Date Of Rate Sheet I nitials - ORG 15,. 2 *ELECTRONIC SIGNATURES REUIRED FOR REVISED BUDGET

7 SUMMARY PROPOSAL BUDGET Cumulativ e ORGANIZATION PROPOSAL NO. DURATION (months ) Cornell University - State Proposed Granted PRINCIPAL INVESTIGATOR / PROJECT DIRECTOR AWARD NO. William M Trochi m ra* A. SENIOR PERSONNEL: P1/PD, Co-PI's, Faculty and Other Senior Associate s Pi s Funds R equeste d B y ( List each se ParatelY with title, A.7. show number in bracket s ) CAL ACAD SUM R proposer 1. - none $ 0 $ ( ) OTHERS (LIST INDIVIDUALLY ON BUDGET JUSTIFICATION PAGE) ' ( 1) TOTAL SENIOR PERSONNEL (1-6) B. OTHER PERSONNEL (SHOW NUMBERS IN BRACKETS ) 1. ( 0) POST DOCTORAL ASSOCIATES ( 0) OTHER PROFESSIONALS (TECHNICIAN, PROGRAMMER, ETC.) ( 0) GRADUATE STUDENTS 4. ( 0) UNDERGRADUATE STUDENTS 0 5. ( 0) SECRETARIAL - CLERICAL (IF CHARGED DIRECTLY) 0 6.( 0)OTHER TOTAL SALARIES AND WAGES (A + B) 0 C. FRINGE BENEFITS (IF CHARGED AS DIRECT COSTS) TOTAL SALARIES, WAGES AND FRINGE BENEFITS (A + B + C) D. EUIPMENT (LIST ITEM AND DOLLAR AMOUNT FOR EACH ITEM EXCEEDING $5,000. ) Fund s granted by NSF (if different ) TOTAL EUIPMENT E. TRAVEL 1. DOMESTIC (INCL. CANADA, MEXICO AND U.S. POSSESSIONS) 0 2. FOREIGN F. PARTICIPANT SUPPORT COSTS 1. STIPENDS $ 26, TRAVEL 0 3. SUBSISTENCE 0 4. OTHER 0 TOTAL NUMBER OF PARTICIPANTS ( 4) TOTAL PARTICIPANT COSTS I G. OTHER DIRECT COSTS 1. MATERIALS AND SUPPLIES 2. PUBLICATION COSTS/DOCUMENTATION/DISSEMINATION 3. CONSULTANT SERVICES 0 4. COMPUTER SERVICES 0 5.5UBAWARD OTHER 0 TOTAL OTHER DIRECT COSTS H. TOTAL DIRECT COSTS (A THROUGH G) I. INDIRECT COSTS (F&A)(SPECIFY RATE AND BASE ) TOTAL INDIRECT COSTS (F&A) 6,60 0 J. TOTAL DIRECT AND INDIRECT COSTS (H + I) 33,00 0 K. RESIDUAL FUNDS (IF FOR FURTHER SUPPORT OF CURRENT PROJECTS SEE GPG II.C.6.j.) 0 L. AMOUNT OF THIS REUEST (J) OR (J MINUS K) $ 33,000 $ M. COST SHARING PROPOSED LEVEL $ 0 AGREED LEVEL IF DIFFERENT $ PIIPD NAM E FOR NSF USE ONL Y INDIRECT COST RATE VERIFICATIO N ORG. REP. NAME* Date Checked Date Of Rate Sheet Initials - ORG C *ELECTRONIC SIGNATURES REUIRED FOR REVISED BUDGE T

8 Budget Justification Pag e In year one, 5/25/06-5/23/07, two students will each be paid $10 per hour and will wor k work 20 hours per week. In year two, 5/24/07-8/29/07, two students will each be paid $1 0 per hour and will work 20 hours per week.

9 SUPPLEMENTARY DOC S Biographical Sketch-Anna Hay s Anna Hays is a junior Human Development major in the College of Human Ecology at Cornel l University. She has an impressive academic record including a 3.9 cumulative GPA, memberships in Psi Chi and the Golden Key National Honor Society, and she was th e recipient of the New York State Scholarship for Academic Excellence. In addition to her recent research experience with Dr. Trochim, Ms. Hays also works as a research assistan t in the Cornell Infant Studies Lab where her responsibilities include testing infants i n habituation and preferential looking studies, data entry and coding, and interviewing parents. She has also worked as a research assistant at the Jacobs Neurological Institut e in Buffalo, NY where she interviewed and tested patients with multiple sclerosis for th e New York State Multiple Sclerosis Consortium. Ms. Hays also helped edit a questionnaire used for a study of quality of life of children with epilepsy and their families. This work was completed during her tenure as research assistant at the Women and Children? s Hospital of Buffalo. Biographical Sketch-Sabrina Rahman Sabrina Rahman is a sophomore Human Biology, Health, and Society major in the College o f Human Ecology at Cornell University. She has an impressive academic record including a 3.52 cumulative GPA, a New York State Merit Scholarship, and is a member of the National Society of Collegiate Scholars. Ms. Rahman has already made significant contributions t o the NSF funded systems evaluation capacity building project by helping with the identification and assessment of Cornell STEM education programs for consideration a s prospective pilot sites. She has also conducted extensive literature reviews related t o best practices in STEM education and evidence-based practice. In addition to her recent research experience with Dr. Trochim, Ms. Rahman also works as a research assistant in th e Laboratory of Rational Decision Making where her responsibilities include the evaluatio n of clinical guidelines and medical decision making for patients with unstable anginas. She has also worked as a medical chemistry research intern at the North Shore-LI J Institute for Medical Research. In this capacity, she investigated the efficacy o f various drug designs in the inhibition of pro-inflammatory activity. In addition, she received advanced training in several chemical techniques and assisted in drug synthesis, writing, and data analysis. Ms. Rahman plans on pursuing a career in the medica l sciences. Page A