NASA - Ames Technology Partnerships Division

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For NASA Internal Users (Researchers and Staff)

Space Act Agreement Information Request
(NASA Ames Research Center )

A Microsoft Word version of the form below may be downloaded and filled out using Microsoft work or compatible word processor and emailed separately.

Microsoft Word template (46KB) saa-template.doc

Please use the form below to submit a Space Act Agreement Information Request. This request is emailed to (Carmela Carrick - Carmela.D.Carrick@nasa.gov)

Partner

For/Title

Purpose

NASA Benefit

Partner responsibilities, effort, information to be provided to NASA

NASA responsibilities, effort, information to be provided to partner

Financial obligations

Milestone schedule

Technical Key Personnel

NASA Person
Name:
Title:
Address:	NASA Ames Research Center Mail Stop: Moffett Field, CA 94035
Tel. No.:	650-604-
Fax. No.:
e-mail:

Participant
Name:
Title:
Address:
Tel. No.:
Fax. No.:
e-mail:

Business Key Personnel:

NASA Person
Name:
Title:	Technology Partnership Manager
Address:	NASA Ames Research Center Mail Stop: 202A-3 Moffett Field, CA 94035
Tel. No.:	650-604-
Fax. No.:	650-604-1592
e-mail:

Participant
Name:
Title:
Address:
Tel. No.:
Fax. No.:
e-mail:

Rights in Data

Signing Officials:

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