The Greener Solutions Program from UC Berkeley’s Green Chemistry Corps

Host Organization Application

Fall Semester, 2012

  1. Host Organization Information:

Company/Organization Name:

Point of Contact Name:

Position:

Phone number:

Email address:

  1. Project Description-

A well defined project with clear objectives and deliverables is critical to the project’s success. Please clearly define these components below.

  1. Please describe the key opportunity or challenge that you would like the Green Chemistry Corps team to help your organization address.
  1. Please list two tothree objectives you expect to achieve as a result of this project and how you might quantify the expected impact. Please keep in mind that ateam of 4 to5 students is expected to finish this project in 14 weeks.
  1. Please list any key dates or timelines for the project for us to consider (the course will runAugust –December, 2012).
  1. Project Engagement

We expect a representative from your organization will serve as a primary point of contact for the student team while working on the project. This interaction is essential for students to get information quickly and to keep the project aligned with the expectations of both parties. He or she should be readily available by email or telephone.

  1. Who will be the point of contact with the Green Chemistry Corps team on this project (if different from individual named in item 1 above)?
  1. How much time perweek will the individual identified in 3a have to dedicate to the completion of this project?
  1. Which senior members of your organization have indicated support for this project, and will they be available to attend the final symposium in December?
  1. Team Composition

Ideally, what skills and backgrounds do you believe will be most valuable for a student team working on this project?

  1. BCGC/DTSC Promotion of Program

In order to promote this program for future students, and to showcase your company’s participation,we hope to use some information from your organization in our outreach efforts. Please indicateif you have any objections to the use of the following information in any outreach material, including website postings and hardcopy publications related to this program:

  • Your company name and logo
  • A project description, or
  • A summary of the final project output.
  1. Confidential Business Information

We anticipate that most projects will not involve intellectual property or confidential business information. In the event that the students must work with confidential business information, however, and potentially produce results that are publishable, please indicate what measures your organization would like taken to protect your CBI.

  1. Host Organization Feedback- If you are selected to participate this semester, we request that you fill out a satisfaction survey once the project has been completed.

Please download this document, enter your information, and mail or email us the completed application to one of the following addresses. Thank you!

The Berkeley Center for Green Chemistry

50 University Hall, #7360

University of California at Berkeley

Berkeley, CA 94720-7360

Attention: Dr. Martin Mulvihill or Dr. Megan Schwarzman

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