2014 Entry Form for the Southeast District Science Day (DSD), Ohio University, Athens OH, March 15.
For each student send $20 entry fee, entry form, OAS Consent & Release Form, ISEF Forms 1, 1A, 1B,
research plan, abstract, & other required forms to reach Dr. E. Gierlowski-Kordesch, Dept. Geological
Sciences, Ohio University, Athens OH 45701-2979 no later than March 1, 2014. Maximum table space is
91 cm wide, 75 cm deep, and 1.2 m high. No floor space available and no 110 V AC.
Please print or type the following in black ink.
Is this is a team project? ______ Then print teammate's complete name: ____________________________
Is this is a continuing project? ___ then include ISEF Form 7 & previous year's Forms 1A, abstract, and research plan.
Circle only one judging category:
1. Behavioral Sci. 2. Biochemistry
3. Botany
4. Chemistry
5. Computer Sci
6. Earth & Space 7. Engineering
8. Environmental Sci.
9. Mathematics 10. Medicine & Health 11. Microbiology 12. Physics
13. Zoology
Student’s
First
Middle
Last name _______________________ Name ____________________ Name _______________________
Social
Must bring SSN on 3/15/14 Home
Circle
Security# to received any cash prize Phone ____________________ Grade________ Gender: F M
Home
Address _____________________________________________ City _______________ Zip ____________
Print Student’s
e-mail address ___________________________________________________________________________
Hometown
School
School
Newspaper _____________________________ County ____________ District ______________________
School
School
Name _____________________________________________________ Phone _______________________
School
Address ______________________________________________ City _______________ Zip ___________
Project Title: Keep it short and to the point. Anything over 60 letters plus spaces will not be accepted.
I, the parent/guardian of the above student, will not hold Ohio University, Ohio Academy of Science,
Science Service, and Discovery Communications, and their representatives responsible for any damage or
injury to the exhibitor at the District & State Science Days, the Southeastern Ohio Regional & International
Science & Engineering Fair, and will assume any liability for injury or damage to others caused by the
student at these events.
Parent’s/Guardian’s
Name (print)
Signature
Date
Use this check list for your entry: A complete entry must include in the order given: ___$20 per student fee, ___2014
entry form, __OAS Consent & Release Statement and the following forms approved, completed, signed, and dated
before experimentation: ___Checklist for Adult Sponsor ISEF Form (1), ___ Student Checklist ISEF Form (1A), ___
Research Plan, ___ Approval ISEF Form (1B), ___Abstract. All entries from one school must be sent in one package
by a school official with a completed “School Information Form” with names of teachers who will judge at the DSD.
ISEF Form (1C) is required if you are required to do your research in a registered research institution, an industrial
laboratory, or school laboratory. See ISEF Form (1) part 6 on when ISEF Forms 2, 3, 4, 5A, 5B, 6A, & 6B are required.
Continuing projects need ISEF Form 7. Download ISEF forms and read the 2014 ISEF Rules at
http://www.societyforscience.org/ISEF/about/rules_regulations.asp
Following areas of research require review & approval by SRC or IRB and complete forms prior to experimentation:
___Humans (prior IRB approval) ISEF Forms 1, 1A, 1B, 4 [1C and 2 if applicable or required by IRB]
___Vertebrate Animals (prior SRC or IACUC approval) ISEF Forms 1, 1A, 1B, (5A + 2) or (5B + 1C + 2)
___Potentially Hazardous Biologic Agents (prior SRC/IACUC/IBC/ approval) ISEF Forms 1, 1A, 1B, 6A
[ISEF Forms 1C, 2, 3, 6B, if applicable. Please read ISEF 2014 Rules for details]
The following area requires the direct supervision by a Designated Supervisor (DS) or a Qualified Scientist (QS):
Hazardous Chemicals, Activities, or Devices. The student must conduct a risk assessment in collaboration with the
DS or QS, documenting the assessment on ISEF Form 3. [ISEF Forms: 1, 1A, 1B, 3 [1C, 2 if required]].