Innovation in Science Clubs: A survey

1. Name of the Science Club *

2. VIPNET Club ID*

3. Address *

District *

State *

4. Year of commencement of Science club: *

5. Type of Science Club

: In-School Out-of-School

6. Details of Science Club coordinator*

Name	Age	Education qualification	Years of engagement with science club

7. Details of other instructors engaged in Science Club for example visiting, part time, contractual, If any:

Name	Profession (example engineers/ Scientists)	Age	Education qualification	Years of engagement/association with science club	Nature of engagement

8.Have the VIPNET club participants/teachers/coordinators developed any scientific or technological solution (innovations) to address the issues or challenge. These innovations help us to improve our everyday life easier*

participants	Applicable to Local level Yes/No	Applicable to national level Yes/No
a. Students
b. Teachers
c.Coordinators
d. Others (specify)

9. Status of Intellectual property created (if any):

Created by Teacher/ students/Others specify	Name	Patent/ copyright/design Status – filed/awarded/ expired	title	reference no.	year

10. Participation and representation at various forum (if children or teachers have participated or received awards and recognitions) relevant for both pass out students and enrolled students (if any).

Name of participant	Year of participation	Name of event	Purpose	Names of Awards	State/Regional/National

11. Did any past/ongoing activity/project of the club was used/channelized for orienting technological activities or solutions on COVID-19 pandemic? Yes/ No

Yes No

12. Details of Scientific and technological activities carried out at the club to combat COVID-19 in last 6 months.

a. b. c.

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