GCSP Licensing Agreement Request

1. Name of Signatory for the licensee *This question is required.

2. Title of Signatory for the licensee *This question is required.

3. Official name of the licensee, such as Rochester Institute of Technology *This question is required.

4. Name of the activity, such as "NAE Grand Challenges Scholars Program at Arizona State University." Could also include "School of Engineering." *This question is required.

5. Description of the activities – For example, raise the awareness of and promote the NAE Grand Challenges Scholars Program at University of Portland through activities such as posters, handouts, website, emails, communications, lapel pins, stoles, medallions, courses, events etc. This can be a default set of activities and the university can add others to the list. *This question is required.