Membership Interest Form

Thank you for your interest in the Genesis Mission Consortium. This form is intended as an expression of organizational interest in potential membership. Information collected will be shared with DOE, other federal agencies, and the Consortium team for consideration purposes. Submission of this form does not constitute a commitment, proposal, guarantee of membership, guarantee of participation in any Consortium activity, or guarantee of access to DOE, National Laboratory, or Consortium resources. Membership is subject to DOE review, execution of applicable agreements, and completion of the Genesis Mission Consortium membership process.

Organizational Information

All fields are required unless marked as optional

Organization Name Organization Size (staff count, revenue, or other relevant descriptor) Organization WebsiteAddress Country of Incorporation

Does your organization have any foreign ownership, controlling interest, or significant foreign influence?

YesNo

Is this submission on behalf of the organization as a whole or a specific team, program, center, campus, school, or business unit?

Organization as a whole Specific team / program / business unit / campus / school / center

Organization Description Describe any prior experience working with DOE, DOE National Laboratories, or other federal R&D organizations.

Contact Information

Primary Point of Contact

Full NameTitle/RoleEmail AddressPhone Number

Alignment with the Genesis Mission

How does your organization's mission or expertise align with the objectives of the Genesis Mission? What unique capabilities, assets, expertise, partnerships, or institutional commitments would your organization bring that would provide value to the Genesis Mission and other Consortium members?

Proposed Areas of Contribution

Please describe the types of capabilities, resources, or expertise your organization could potentially make available to support the Genesis Mission and Consortium activities. Final commitments are discussed and defined later in coordination with DOE.

Potential Contributions (select all that apply):

Computing infrastructure, cloud, or HPC resourcesData assets, repositories, or data infrastructureAI models, software, workflows, or digital toolsExperimental facilities, laboratories, instrumentation, or testbedsScientific, engineering, technical, or research expertiseWorkforce development, education, training, internships, or fellowshipsFinancial or in-kind supportStandards development, best practices, or community leadershipOther (please describe)

Describe the proposed resources, why they may be significant, and how they could advance Genesis Mission priorities or provide value to Consortium members. Provide an indicative, non-binding order of magnitude, level of effort, or scale for the potential contribution, if known.

Organization Needs and Wants

What are you hoping to receive from DOE/Genesis Mission?

Ideas, Concepts, or Project Interests

(Optional)

Do you have initial ideas, concepts, or project areas that could support Genesis Mission objectives?

Additional Information

(Optional)

Is there anything else you would like DOE or the Consortium team to know about your organization or interest in the Genesis Mission Consortium?

I acknowledge that submission of this form does not guarantee membership, participation, selection for any Consortium activity, access to DOE/National Laboratory/Consortium resources, funding, or working group participation. I acknowledge that information submitted may be shared with DOE, other federal agencies, and the Consortium team for review and consideration purposes. I acknowledge that any potential membership or contribution will be subject to DOE review, applicable due diligence, execution of required agreements, and completion of the Genesis Mission Consortium membership process. I acknowledge that proposed contributions described in this form are for initial review and discussion and do not create a binding obligation unless and until reflected in applicable membership or project agreements.