MTSU
Faculty/Staff Member Information
First
Name:
*
Last
Name:
*
Department:
*
College:
Division:
- No Selection -
Academic Affairs
Business and Finance
Development
President's Office
Student Affairs
Information Technology
Other
Phone:
Email:
# of Faculty Involved:
*
# of Students Involved:
* (value can be zero)
Partner Information
Name
of Partner:
*
Title
of Partnership:
*
Begin
Date of Partnership:
*
End
Date of Partnership:
* (if no end date, enter "ongoing")
Contact
Contact
Contact
Title:
Address:
City:
State:
Zip:
Country:
Phone:
Email:
Website:
Partner
is in what region/area?
Partner
is what type of entity?
If
other, please describe:
Brief
description or purpose of partnership:
*
Classification
of prospective partnership? (check all the apply)
Will
there be a written or signed agreement that describes responsibilities
and benefits to each partner?
Select
the MTSU Academic Master Plan Partnership Strategy that this
prospective partnership most closely applies to:
Site
of partnership operation?
MTSU
resources (check all the apply)
If
financial, what will be the amount of MT resources?
(enter NUMBERS only)
Partner's
resources (check all that apply)
If
financial, what will be the amount of partner's resources? *
(enter NUMBERS only) *
Is this funded by a grant ?
*
Briefly
describe the tangible and intangible benefits to be received
by MTSU.
What is the impact on MTSU as a result of this partnership (i.e learning opportunities, professional, other benefits)?
*
What is the impact on students?
*
What is the impact on faculty?
*
Can
you quantify the benefits?
If
yes, how?
What is the impact on the community/partner as a result of this partnership (i.e research, practical, workforce and economic development, social/cultural, other benefits)?
*
How is this partnership assessed?
*
What is the outcome of the assessment?
*
What faculty scholarship is associated with this partnership? (check all that apply and provide a brief description of each) *
Please
add additional information as needed.
Carnegie?
