63rd ANNUAL TIDEWATER SCIENCE & ENGINEERING FAIR Science Fair – Saturday, March 15, 2014 Old Dominion University, Webb Center http://www.cs.odu.edu/~scifair/RegionalFair/ President: Mary Patterson, [email protected] Vice President: Chris Osgood, [email protected] Junior 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 emails 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 email request to the director for needed information. Helpful websites: Tidewater Science and Engineering Fair http://cs.odu.edu/~scifair/RegionalFair/index.html   Application Helpful information   Regulations ex. needed prior approval, displays, animal usage, humans, and more Information about additional forms that may be required Broadcom Masters (Junior Division of ISEF) http://www.societyforscience.org/page.aspx?pid=605 Student Calendar: Fall Get ideas organized. Write up a proposed research plan and get it approved. Complete the TSEF Junior Division Application. Fill out the student checklist and risk assessment to determine if any ISEF forms are required. The following items are required to be included with ALL Junior Division applications: o TSEF Junior Division Application o Research Plan o Abstract Fall - winter Work on project, modifying research plan as needed. Compete in local science fairs (if available). Mon., Jan. 20th Adult Contacts must send in student database to TSEF. Wed., Jan. 22nd Adult Contacts must deliver 2 copies of completed student application to TSEF. Mid. Feb. Acceptance/Rejection notices emailed to Adult Contact by TSEF Late Feb. Electronic copy of Student Abstract (in Word – see TSEF website) due to TSEF Sat., Mar. 15th TSEF at Webb Center on the campus of Old Dominion University Feb. - June Broadcom MASTERS application open for invited students. 63rd TIDEWATER SCIENCE & ENGINEERING FAIR JUNIOR 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: 6 ____ 7 ____ 8 ____ Team Member #2 ________________________________ Team Member #3 ____________________________ (Teams must provide additional information on page 4) Home Address_____________________________________________________________________________________________ Number Street City/Town Zip Code Email Address:______________________________________ Phone Number:(_____)____________________ School Name: _____________________________________________ School Division: _________________________ School Address:____________________________________________________________________________________________ Number Street City/Town Zip Code 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) Behavioral & Social Sciences (BE) Biochemistry (BI) Chemistry (CH) Computer Science (CS) Earth & Planetary Science (EA) Energy & Transportation (ET) Engineering: Electrical & Mechanical (EE) Engineering: Materials & Bioengineering (EN) Environmental Sciences (EV) Mathematics (MA) Medicine & Health Sciences (ME) Microbiology (MI) Physics and Astronomy (PH) Plant Sciences (PS) These categories are explained at the ISEF web site: http://www.societyforscience.org/isef/ All the information is required for submission. If you do not have an email 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) _____________________________________________ Signature of Adult/Teacher Sponsor Adult/Teacher Sponsor Email 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 2014. 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 Junior 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. Check below in the given blank to indicate you have included each needed form in your packet. Tidewater Science and Engineering Fair forms: ____ Tidewater Fair Application: page 1(titled Student Application), page 2 (this page), page 3 (Media Release) ____ Research Plan ____ Abstract ____ TEAM Projects only: page 4 (Team Information) and a Media Release Form for each student participant Broadcom Masters (Junior Division of ISEF) Risk Assessment and Forms Checklist: Complete prior to the start of your research. Identify and assess the risks involved in this project. Does your project use: ___ 1. Glassware ___ 2. Heat Source ___ 3. Chemicals ___ 4. Human Subjects* (requires IRB approval – complete ISEF Form 4 and Informed Consent Forms for each participant) ___ 5. Vertebrate Animals* (requires SRC approval – complete ISEF Form 5a or 5b) ___ 6. Hazardous Chemicals* (see page 18 of the ISEF Rules Handbook) ___ 7. Potentially Hazardous Biological Agents* (Microorganisms, human/animal tissue, recombinant DNA) (requires ISEF Form 6a or 6b) *If you checked items 4-7, your project may require additional forms and pre-approval by a Science Review Committee (SRC) or Institutional Review Board (IRB). Complete ISEF forms 1A and 1B with all other required forms, and submit with this application. Answer the questions below. These forms may be found at the ISEF web site: http://www.societyforscience.org/isef/ 1. Describe the safety precautions and procedures that will be used to reduce the risks. 2. Describe the disposal procedures that will be used. If not applicable, please write in “NA”.   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. _________________________ Student’s Name Printed _________________________ School _________________________ Adult/Teacher’s Name Printed _____________________________ Student Signature _____________________________ Parent/Guardian Signature _____________________________ Adult/Teacher Signature ___________ Date (before start date) ___________ Date (before start date) ___________ Date (before start date) 2 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: Signature School: Student: ____________________________ Signature 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: Signature PLEASE PRINT CLEARLY Address: ____________________________________________________________ City State Zip Code Email contact: _____________________________ Home Phone #: __________________________ Date: 3 Team Member Information Complete ONLY if this is a team project. COMPLETE THE FOLLOWING FOR THE 2nd TEAM MEMBER: NAME: ___________________________________________________________________ First Home Address: Last ________________________________________________________________________ Number Street City/Town Zip Code Email address: _______________________________________ Phone number: (______)______________ Parent/Guardian Signature: _______________________________ School Name: __________________________ Grade Level: __________________Gender:______ COMPLETE THE FOLLOWING FOR THE 3rd TEAM MEMBER (if appropriate): NAME: ___________________________________________________________________ First Home Address: Last ________________________________________________________________________ Number Street City/Town Zip Code Email address: _______________________________________ Phone number: (______)______________ Parent/Guardian Signature: _______________________________ School Name: __________________________ Grade Level: __________________Gender:______ Adult Sponsor for the group Teacher or Adult Sponsor: __________________________________ Phone Number(s):___________________________________________ School or Work Place:_______________________________________ Email address:______________________________________________ 4