Place Participant Label Here
62nd State Science and Engineering Fair of Florida
March 28 – 30, 2017 The Lakeland Center, Lakeland
FFFS Office Use Only
SSEF ENTRY Form (Page 1)
Only original Entry Forms are accepted
Step #1: Choose Section: double check to make sure you select the correct level of competition.
Is this a TEAM PROJECT?
S Senior Section (Grades 9-12)
YES
NO
J Junior Section (Grades 6-8)
Step #2: Project Information: double check to make sure you select the correct category.
Project Category:
ANIM
ENEV
Animal Sciences
Environmental Engineering
BEHA
IMRS
Behavioral & Social Sciences
Intelligent Machines, Robotics & Systems Software
BMED
MACO
Biomedical & Health Sciences
Mathematics & Computational Sciences
CMBI
MICR
Cellular/Molecular Biology & Biochemistry
Microbiology
CHEM
PHYS
Chemistry
Physics & Astronomy
EAEV
PLNT
Earth & Environmental Sciences
Plant Sciences
ENMS
Engineering
Project Title: (must match ABSTRACT title): ________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Project Arrangement: COMPLETE ACCURATELY – table configuration CANNOT be changed on site.
TN
Table/No Electricity
TE
Table/Electricity*
Please select method of payment for electricity ($70):
FN
Floor/No Electricity
FE
Floor/Electricity*
Check
Money Order
Purchase Order
• Electricity ($70) payment must accompany this form. Personal checks, school checks, purchase orders,
and money orders must be made payable to the FFFS/SSEF. Electricity for lighting purposes will not
be allowed.
Step #3: Personal Information for Individual Registrant or Team Leader of a Team Project
Note: if this is a TEAM PROJECT, Team Members complete additional pages 3 and 4.
__________________________________________________________
Registrant’s (Team Leader) Name:
First Name
Middle Initial
Last Name
Sir Title (Jr., II, etc)
__________________________________________
Phonetic Spelling:
Gender:
Male
Female
First Name
Last Name
*Participant’s OWN Email address (required): ________________________________________________
*It is required that the participant enter his/her OWN EMAIL ADDRESS for ID purposes
________________________________________________________, FL______________
Mailing Address:
Number and Street
City
Zip+4
_____ - _____ - ________
____ /____ /____
______
Home Phone #:
Date of Birth:
Grade in School:
Ethnicity:
African American
American Indian/Alaskan Native
Asian or Pacific Islander
Caucasian
Other
Hispanic