Merchandise Approval Request Form * indicates a required field TBD — ADD COUNTRIES WHEN AVAILABLEPlease note, NASA has limited resources to pursue collaborative projects, and we prioritize partnerships with organizations that have the interest in and ability to broadly share NASA content, stories, and inspiration in a way that is impactful, and accessible to the public, and/or reaches non-traditional and underrepresented audiences. Organization Name*Headquarters AddressAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact InformationName* First Last Email Address* U. S. Phone Number*International Phone NumberIf outside the United States, please include the country code.About the Proposed PartnershipProvide a short description of your proposed project and any anticipated products.*Describe what your organization will provide in this collaboration.*Describe what non-financial support you are seeking from NASA.*How will this partnership benefit the U.S. general public?*Detail the project timeline and any deadlines anticipated.*Additional InformationAudience InformationCurrent Audiences* General public Spanish-language Underserved communities Urban communities Rural communities Kids Students Educators United States International Select all audiences your organization currently engages regularly.Partnership Target Audiences* General public Spanish-language Underserved communities Urban communities Rural communities Kids Students Educators United States International Select all audiences your organization seeks to engage with this partnership.What, if any, efforts will be made to ensure content reaches underserved communities?** The term “underserved communities” refers to populations sharing a particular characteristic, as well as geographic communities, that have been systematically denied a full opportunity to participate in aspects of economic, social, and civic life. Underserved communities include: people with disabilities; LGBTQIA+ individuals; individuals with limited English proficiency; older adults; people of color; individuals in rural communities; first-generation professionals, college students, and immigrants; formerly incarcerated individuals; persons adversely impacted by persistent poverty, discrimination, or inequality; women; individuals facing religious discrimination; veterans and military spouses; and parents, caregivers, and individuals facing pregnancy discrimination. (See NASA’s Strategic Plan for Diversity, Equity, Inclusion and Accessibility)Digital PlatformsFor all social media accounts used by your organization, please provide the user names/handles only. Do not provide URLs.X (Twitter)FacebookInstagramFlickrYouTubeBlogOthersTotal # of social media followers/subscribers*Organization website* Website traffic (unique visits/month)*Distribution & PromotionHow will the results of the project be disseminated?*Gaming, E-sports or Virtual Reality PlatformsSelect Platforms Xbox PlayStation Nintendo Other gaming console (specify in Notes) Handheld gaming device (specify in Notes) iOS/Android/Samsung Web-based gaming platform (specify in Notes) NotesWill the public have access to results of the partnership at no cost?* Yes No Promotion Activities* Press release/wire service Broadcast media coverage Print media coverage Online media coverage Other (explain below) Select all that apply.Additional Promotion InformationAcknowledge & SignBy typing my name in the field below, I acknowledge that I understand: This form is used by NASA only to collect the preliminary information required to assess the potential of a proposed partnership and in no way binds or obligates NASA to work with me or my organization on this or any activity. My submission of this form is strictly voluntary. My submission does not include any non-public or proprietary information. NASA is not responsible for any costs associated with my preparation of this submission. This intake form is not an offer or solicitation for goods or services, and my submission of information does not result in any obligation on the part of NASA. Visit NASA.govType Name* First Last CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
