LOUISIANA REGION 10 SCIENCE & ENGINEERING FAIR 2016
NICHOLLS STATE UNIVERSITY
ENTRY FORM
REGISTRATION FEE IS $17 PER PERSON OR $30 PER TEAM.
MAKE CHECKS PAYABLE TO NICHOLLS STATE UNIVERSITY.
Name_____________________________________________________________________________
Home Address ____________________________City ______________________ LA Zip________
Phone_________________________ Grade_________
Gender:
M
F
School_________________________________________Parish______________________________
School Address ____________________________City_____________________ LA, Zip_________
Teacher__________________________________ School Phone _____________________________
E-Mail Address of Sponsor: _____________________________________________________________
(Must Include--All Fair Information will be sent to the above email address)
Division: check one
________Junior (Grades 6-8)
_________Senior (Grade 9-12)
Category: check one
____ Animal Sciences
____ Behavioral & Social Sciences
____ Biochemistry
____ Biomedical & Health Sciences
____ Cellular & Molecular Biology
____ Chemistry
____ Computational Biology & Bioinformatics
____ Earth & Environmental Sciences
____ Embedded Systems
____ Energy: Chemical
____ Energy: Physical
____ Engineering Mechanics
____ Environmental Engineering
____ Materials Science
____ Mathematics
____ Microbiology
____ Physics & Astronomy
____ Plant Sciences
____ Robotics & Intelligent Machines
____ Systems Software
____ Team Project, specify category below (ex: Chemistry) ______________________________
Title of Project: _____________________________________________________________________
Exhibit Size: (Maximum size of 48" wide by 30" deep and 107" height)
Width__________inches
Depth_____________inches
Height________inches.
Were live vertebrate animals or humans used? ____Yes _____No
If yes, Copies of Protocols and certifications must be attached to the entry form.
I certify that this project was my work alone.
ENTRY FORM DEADLINE TO NSU: February 15, 2016
Exhibitor’s Signature__________________________________________________ Date________________________
I certify that the above named student did this project under my supervision or as noted on the attached certificates required
for vertebrate or human research.
Teacher’s Signature __________________________________________________ Date________________________
This is just the entry form: There are additional forms you must fill out to complete your project, these forms MUST be
completed and submitted with your Entry Form. Check our website for information on each additional form.
http://www.nicholls.edu/continuing-ed/science-fair/
Revised 01/04/2016
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48th LOUISIANA REGION X SCIENCE& ENGINEERING FAIR