Senior Division Student Application Cover Sheet

Transcription

1 63 rd ANNUAL TIDEWATER SCIENCE & ENGINEERING FAIR Science Fair Saturday, March 15, 2014 Old Dominion University, Webb Center President: Mary Patterson, Vice President: Chris Osgood, Senior Division Student Application Cover Sheet Read this information before starting the application. (DO NOT send this sheet with the application.) General Information: The regional Tidewater Science and Engineering Fair (TSEF), affiliated with the International Science and Engineering Fair (ISEF), drew almost 300 students, grades 6 12, from the Greater Tidewater area to its March 16, 2013 event that was held on the grounds of ODU. Winners received over $7,200 in prizes and gifts from local and national organizations. Four of the senior category winners placed at the Virginia Science and Engineering Fair and the two top students received an all- expense trip to the ISEF event in Phoenix, Arizona. The top junior division winners were invited to further compete with the Broadcom MASTERS program in Washington, DC. Information Contacts: The fair director regularly sends s to a group of adult contacts, mostly people in education, within the designated area. These contacts then send out TSEF information to individual schools and teachers, who disperse it to students. This is designed to help students navigate the ISEF regulations and forms. Students without a known contact can send an request to the director for needed information. Helpful websites: Tidewater Science and Engineering Fair Application Helpful information International Science and Engineering Fair Regulations ex. needed prior approval, displays, animal usage, humans, and more Required forms: Form (1), Form (1A), Approval Form (1B), and Form (3). (See calendar below.) o Several other forms may be needed. Ex. living materials and chemicals Wizard o The most important site for anyone starting this process. It will help to determine the needed forms and it will lead to suggested sites for more information. Student Calendar: Fall Get ideas organized. Write up a proposed research plan and get it approved. ALL of the following forms must be completed BEFORE experimentation o ISEF form (1) - Checklist for Adult Sponsor o ISEF form (1A) - Student Checklist o ISEF form (1B) - Approval Form complete top portion. IF NEEDED, the Scientific Review Committee must sign either section a or b in center. DO NOT SIGN the very bottom, section 3. This will be signed by the TSEF Committee if the project is Fall - winter Mon., Jan. 20 th Wed., Jan. 22 nd Mid. Feb. Late Feb. Sat., Mar. 15 th Sat., Mar. 28 th May th accepted into the TSEF event. o ISEF form (3) - Risk Assessment Work on project, modifying research plan as needed. Compete in local science fairs (if available). Adult Contacts must send in student database to TSEF. Adult Contacts must deliver 2 copies of completed student application to TSEF. Acceptance/Rejection notices ed to Adult Contact by TSEF Electronic copy of Student Abstract (in Word see TSEF website) due to TSEF TSEF at Webb Center on the campus of Old Dominion University Virginia State Science and Engineering Fair at VMI for invited students ISEF in Los Angeles, California for invited students

2 63 rd TIDEWATER SCIENCE & ENGINEERING FAIR SENIOR DIVISION STUDENT APPLICATION Science Fair Saturday, March 15, 2014 Old Dominion University (Please Print or Type) Name/Team Spokesperson: Gender: (circle) M or F Grade: Team Member #2 Team Member #3 (Teams must provide additional information on page 4) Home Address Address: Phone Number:( ) School Name: School Division: School Address: Title of Entry: STOP and THINK: Title should be clearly written and must match on all documents. It CANNOT be changed once submitted. Category (All projects, including Team, must choose from the selections below.) *You cannot choose any other categories except those listed here (TSF uses 15 of the 17 ISEF categories): Animal Sciences (AS) Earth & Planetary Science (EA) Mathematics (MA) Behavioral & Social Sciences (BE) Energy & Transportation (ET) Medicine & Health Sciences (ME) Biochemistry (BI) Engineering: Electrical & Mechanical (EE) Microbiology (MI) Chemistry (CH) Engineering: Materials & Bioengineering (EN) Physics and Astronomy (PH) Computer Science (CS) Environmental Sciences (EV) Plant Sciences (PS) These categories are explained at the ISEF web site: All the information is required for submission. If you do not have an address, you need to provide one for which this adult can be contacted. I certify that the student(s) name(s) on this application is/are a student(s) of the named school. Name of Adult/Teacher Sponsor (Please Print) of Adult/Teacher Sponsor Adult/Teacher Sponsor Address: School or Work location Phone number (include area code) IMPORTANT DATE for Designated Contact Persons (determined by school or division) - Wednesday, Jan. 22, 2014 Two copies of the application packet including all required forms and abstract must be submitted in person by the Designated Contact Person: at New Horizons (Hampton) from 8 am to noon OR at the Advanced Technology Center (Va. Beach) from 2:30 pm to 5 pm ***Keep the original of all forms to display with your project at the fair.*** All applicants will be notified by the end of February Category selection and project title are responsibilities of the students. Once submitted, they cannot be changed. THERE IS NO APPEALS PROCESS. The decision of the Judges is final. 1

3 Senior Division Student Application: Checklist Category: Experiment Start Date: Experiment End Date: ALL PROJECTS: Be certain that all blanks on all forms are completed, including SIGNATURES and DATES. Proper dates are important. Carefully read each form to see if the date should be BEFORE or AFTER the experimentation. The application packet is a combination of Tidewater Science and Engineering Fair forms and ISEF forms. Check below in the given blank to indicate you have included each needed form in your packet. Submit your forms in the following order: Tidewater Science and Engineering Fair forms: Tidewater Fair Application: page 1(titled Student Application), page 2 (this page), page 3 (Media Release) If a TEAM project: page 4 (Team Information) and a Media Release Form for each student participant International Science & Engineering Fair forms: Abstract Use ISEF abstract form Form (1) Checklist for Adult Sponsor Form (1A) Student Checklist completed and signed Research Plan Form (1B) Approval form These forms may be found at the TSEF web site: These forms may be found at the ISEF web site: part 1, required of all projects - completed and signed (Note: date BEFORE experimentation begins) part 2, completed and signed IF NEEDED part 3, will be signed by the Tidewater Science Fair Review Committee if accepted Form (3) Risk Assessment Form Required for all projects Address usage of any glassware, heat, devices, chemicals, or regulated substances. (Required Designated Supervisor may be the Adult Sponsor.) The following are additional ISEF forms that are required for certain types of projects. Not filling out required forms properly (ex. dates) will result in the disqualification of a project. Please continue to place them in this order, if needed. Human Subjects - if your project involves human subjects in any way, complete Human Subjects Forms (4), which must be signed by your school division s Institutional Review Board BEFORE experimentation begins. Include the completed Qualified Scientist Form (2), dated before the experimentation begins. One blank copy of the used Informed Consent Form must be included (even if you use the ISEF form). Keep the signed forms in a secure place within your school. Do NOT send in copies of these signed forms to the TSF. Hazardous Biological Agents - If your project involves microorganisms, controlled substances, hazardous substances/devices, recombinant DNA, fresh tissue, blood or body fluids, complete (should be dated before the experimentation begins): Qualified Scientist Form (2) Potentially Hazardous Biological Agents Risk Assessment Form (6A) and/or Human and Vertebrate Animal Tissue Form (6B) Vertebrate Animals - If your project involves vertebrate animals, complete (should be dated before the experimentation begins): Vertebrate Animal Form (5A) if conducted within a school or home or Form (5B) if in a regulated research institution Qualified Scientist Form (2) Research Settings Other than Home -If your project is conducted at an institutional or industrial setting (hospital, medical centers, physician s office, Thomas Jefferson Lab, NASA, a university, etc.), complete Form (1C). Continuing Research -If your project is a continuation in the same field of study from a previous year(s ) project, complete Form (7). Submit two stapled copies of your application packet in the correct order. Carefully check dates and signatures. RETAIN YOUR ORIGINAL APPLICATION PACKET OF FORMS and BRING IT WITH YOU TO THE FAIR. 2

4 MEDIA RELEASE FORM NOTE: If this is a team project, each member must submit a completed form. I, (Student's Name), do hereby give the Tidewater Science and Engineering Fair, its assigns and legal representatives, the irrevocable right to use my picture or photograph in all forms and media and in all manners, including composite representations, for any lawful purpose in its publications and displays. I waive any right to inspect or approve the finished product, including written copy that may be created in connection therewith. I have read this release and understand its contents. Parent/Guardian: School: Student: Date: CONSENT I am the parent and/or guardian of the minor named above and have the legal authority to execute the above release. I approve the foregoing and waive any rights in the premises. Parent/Guardian: PLEASE PRINT CLEARLY Address: City State Zip Code contact: Home Phone #: Date: 3

5 Complete ONLY if this is a team project. Team Member Information COMPLETE THE FOLLOWING FOR THE 2 nd TEAM MEMBER: NAME: First Last Home Address: address: Phone number: ( ) Parent/Guardian : School Name: Grade Level: Gender: COMPLETE THE FOLLOWING FOR THE 3 rd TEAM MEMBER (if appropriate): NAME: First Last Home Address: address: Phone number: ( ) Parent/Guardian : School Name: Grade Level: Gender: Adult Sponsor for the group Teacher or Adult Sponsor: Phone Number(s): School or Work Place: address: 4