Gsdsef Form 1 - Project Proposal/signature Form
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3GREATER SAN DIEGO SCIENCE & ENGINEERING FAIR (GSDSEF)
PROJECT PROPOSAL/SIGNATURE FORM (GSDSEF form 1, 2017)
T h i s form should be completed and signed prior to starting project work. It m u st b e given to your teacher
who will file it for quick reference if needed.
(Use the “Tab” key to move from line to line)
1. Project Title
____________________________
__
__
Is this a continuation of a previous project?
Yes
No
2. STUDENT'S NAME (Last, First, Middle)_____________________________________________________________________
2a. Partner’s Name (for Senior Division 2 person projects only)
_____________________
EACH SENIOR DIVISION PARTNER MUST SUBMIT a separate project proposal form.
3. Address, City, Zip
_____________________
4. Phone
email
___________________________________
5. School
________________Grade
______________
6. Teacher
__________________________________________________________________________________________________________________________
7. This project involves (check all that apply):
r Live Vertebrate Animals
(GSDSEF-2, 2017)
r Humans as subjects, helpers, or interviewees
(GSDSEF-3, 2017)
r Hazardous Substances (anything that could cause injury)
(GSDSEF-4, 2017)
r Chemicals
r Infectious Agents
r Bacteria, Fungi and/or Molds
r Mutagenic Agents
r Carcinogenic Agents
r Teratogenic Agents
r Human or Other Vertebrate Tissue
(GSDSEF 5, 2017)
8. Items checked in #7 above, must have the relevant Certification form(s) listed below filled out and
completion verified b y y o u r t e a c h e r (CHECK ALL THAT APPLY):
______Certification of Humane Treatment of Live Vertebrate Animals (GSDSEF 2, 2017)
______Certification of Compliance of Research Involving Humans (GSDSEF 3, 2017)
______Certification of Hazards Control (GSDSEF 4, 2017)
______Certification of Vertebrate Tissue Source & Safety (GSDSEF 5, 2017)
9. Location where experimental procedures will take place:__________________________________________________
_______________________________________________________________________________________________________________________________________
10. People, companies, etc. providing equipment, materials, workspace:_______________________________________________
_______________________________________________________________________________________________________________________________________
11. Proposed project Category:_________________________________________________________________________________
(see “Category Description” on page 10 of the Sample Notebook or on the GSDSEF website
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