General Information

Is this a new application or a replacement?* New Replace

If "replace", provide Application ID to replace: (e.g. PIO-10-nnnn)

Have you applied for this award in previous rounds?* No Yes

Is this award for yourself or
a group project in which you are a key member?* Myself Group Project

Personal Information

First (given or personal) Name*

Last (family) Name*

Email*

Re-type Email to verify*

Address*

City*

State/Province/Region*

Postal/Zip Code

Country*

Phone Number*
(Include country and/or area code)

Are you a current member of Systers?* No Yes
(NOTE: Award recipients are expected to join the Systers community for the period of one year.)

If yes, what year did you join?   1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Biography*
(In one paragraph, please tell us about yourself)

Project Information

Title of Project*

Brief Description of Project* (25,000 characters maximum)
(Projects are expected to benefit one or more women or girls in an activity related both to the field of computing and to being a woman. We expect the project to have some lasting effect. We will not fund purchases of food or gifts, and we do not contribute to other organizations. We do fund equipment, educational costs, conference costs, books, supplies for hands-on activities and other expenses related to activities involving computing technology. If you are in doubt, please email your questions to us at "passiton-12may2010 AT systers DOT org".)

How will you "pass it on"* (25,000 characters maximum)
(Brief description of what you would do to "pass it on" if you receive an award.)

Outline Budget of Award* (25,000 characters maximum)
(Please describe how you would spend the money, if you receive an award.)

Other sources of funding* (25,000 characters maximum)
(Please describe how you will fund any parts of your project which would not be covered by an award from Systers. State "none" if you have no other funding.)

Letter of Reference

Please provide a letter from someone who is familiar with your planned project and with your past accomplishments, such as a teacher, employer or colleague. The letter of reference will need to be sent either electronically (JPG or PDF format) or by postal mail on a letterhead. We strongly encourage them to submit the letter electronically. The letter should contain the referral's contact information, so that we may request paper verification, if necessary.

Electronic letters of reference should be sent to: passiton-12may2010 AT systers DOT org

Paper letters should be sent to:

Attn: Anita Borg Pass-it-on Awards
Anita Borg Institute for Women and Technology
1501 Page Mill Road, ms 1105
Palo Alto, Ca 94304 USA

Reference letter must be received by us no later than 5:00 PM May 19, 2010 PST (UT-8). This deadline is firm. Only applications with referral letters will be considered.

Information about person writing referral letter

Name*

Title

Phone*
(Include country and/or area code)

Email*

Re-type Referral's Email to verify*