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