Wisconsin Idea Submission Form   UW-Madison is launching a campus-wide project to bring greater visibility to the many ways that faculty, staff and students engage in the Wisconsin Idea. This brief form intends to capture some basic information about how and where your education, research, clinical or outreach programs significantly involve Wisconsin citizens in tangible ways, and how that work is making an impact. While we realize many people are likely involved in each project, we ask that you select one person to list as the project leader. Please submit individual projects separately. Thank you for your contribution!       1. Name of the activity/program/project/course/study: Official or working title of initiative you plan to describe.         Information on project leader       2. First Name   Last Name   Title   School/College/Division -- None -- Agricultural and Life Sciences Business Continuing Studies Education Engineering Enrollment Management Nelson Institute Graduate School Human Ecology International Studies Law Letters and Science Medicine and Public Health Nelson Institute Nursing Pharmacy Veterinary Medicine Dean of Students University Administration   Select from the drop down menu above. If you represent a unit other than those listed above, please leave this field blank and indicate your department name in the item below.   Department     Information on the involvement     3. Please describe (100 words or less) the nature of your work in the state:         4. Primary area of focus (select the most appropriate answer):   Economic Development Quality of Life Arts and Culture Education Agriculture Environment Health Care           5. Who are your beneficiaries of your work? Select all that apply   Business leaders Educators Non-Profit organizations Wisconsin workers Health care professionals Local and state gov't officials K-12 students Patients Wisconsin families Other, please specify UW students and families Civic and community groups       6. Who is involved in this project? Select all that apply   Undergraduate students Grad students Faculty Academic Staff Classified Staff         7a. Who are your external partners? Select all that apply   Businesses Health care organizations Local and state gov't officials Educators Civic and community groups Other UW System institutions Other, please specify Statewide media         7b. Please provide specific names of partners:   Businesses   Educators   Other UW System institutions   Health care organizations   Civic and community groups   Local and state gov't         8. What are the most tangible outcomes or economic benefits stemming from this work? Please provide concrete examples and use numbers when possible         9. City/town/area benefiting from the work e.g., Milwaukee, Lake Michigan, Statewide         10. Wisconsin County Please select all that apply from the alphbetical list below.   Adams Ashland Barron Bayfield Brown Buffalo Burnett Calumet Chippewa Clark Columbia Crawford Dane Dodge Door Douglas Dunn Eau Claire Florence Fond du Lac Forest Grant Green Green Lake Iowa Iron Jackson Jefferson Juneau Kenosha Kewaunee LaCrosse Lafayette Langlade Lincoln Manitowoc Marathon Marinette Marquette Menominee Milwaukee Monroe Oconto Oneida Outagamie Ozaukee Pepin Pierce Polk Portage Price Racine Richland Rock Rusk Saint Croix Sauk Sawyer Shawano Sheboygan Taylor Trempealeau Vernon Vilas Walworth Washburn Washington Waukesha Waupaca Waushara Winnebago Wood   Other, please specify       11. How long will the project continue?   Please select appropriate answer... One semester Academic year Calendar year Two-three years Longer than 3 years Other, please specify below Other:       12. Program Web Site:         13. Name of person entering information:         14. Your Email Address:         15. Any additional information you would like to add: