Email address
of teacher_________________________________
Grade Level ______________
SOUTH PLAINS REGIONAL SCIENCE & ENGINEERING FAIR
OFFICIAL ENTRY FORM
Name: (first)_____________________(middle)________________(last)__________________________
Home Address______________________________________________________________
Street
City
State
Zip
Circle one: Male / Female
School Year: 2015 – 2016
Fair Date: February 5, 2016
School_______________________________________________________________________________
School Address_______________________________________________________________________
Street
City
State
Zip
Telephone (school)_____________________________ (home/cell)______________________________
(other than school)
Division
Biological
CATEGORIES
(Senior (9th-12th) Level Projects Only)
Physical
___
___
___
___
___
___
___
Elementary
Grades 4-5
Middle School
Grade 6 - 8
Senior High
Grades 9-12
Behavioral & Social Science
Biochemistry
Computer Science
Earth & Space Science
Environmental Science
Medicine & Health
Physics
___
___
___
___
___
___
Botany
Chemistry
Engineering
Mathematics
Microbiology
Zoology
Project Title__________________________________________________________
Does the project involve:
Controlled substance ____
Vertebrate Animals ____
Human Tissue
____
Project dimensions:
Recombinant DNA ____
Lasers
____
Human Subjects
____
Height 72 inches
Width 48 inches
Depth 30 inches
Requires Electricity:
Yes______ No______
The student named above has completed an outstanding science/engineering project and is a designated representative of our school.
Permission is hereby granted to enter the project in the South Plains Regional Science & Engineering Fair.
Teacher________________________________________Parent______________________________________