Research Plan Form 1a - 2015 Massachusetts State School Science & Engineering Fair Middle School Division
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1Region__________
RSRC approval________
2015 MASSACHUSETTS STATE SCHOOL SCIENCE & ENGINEERING FAIR
MIDDLE SCHOOL DIVISION
SATURDAY, JUNE 6, 2015
RESEARCH PLAN FORM 1A
Please keep a copy of this application and any accompanying material for your records.
Student(s) Name_______________________________________________________________ Grade _______
Project Title ________________________________________________________________________________
Teacher/Adult Supervisor _____________________________________________________________________
School _________________________________________City/Town __________________________________
Teacher Phone _________________________________Teacher Active Email _________________________
Please check one:
Individual Project
or
Team Project (
All forms must be filled out by all team
members)
PROJECT MUST NOT INVOLVE THE
ALL HUMAN RESEARCH PROJECTS MUST
FOLLOWING MATERIALS:
HAVE AN INFORMED CONSENT FORM (C)
Blood products, fresh tissue, teeth and bodily fluids
ATTACHED
Nonhuman vertebrate animals or their parts, except eggs
Pathogenic agents
All human research projects (including surveys, professional
Recombinant DNA
tests, questionnaires, and studies in which the researcher is
Ingestion or inhalation of any substance by human subject--
the subject of his/her own research) need a Regional Safety
(no smelling/wafting or eating/chewing of ANYTHING)—
Review Committee (RSRC) approval. Copies of
NOTHING in or on parts of mouth—including but not limited
standardized and student prepared tests, surveys, etc. must
to teeth, tongue, lips.
be attached to the Research Plan. HUMAN CONSENT
Controlled substances
FORM (C) must be obtained from all participants involved in
Carcinogenic, mutagenic and toxic chemicals
human research projects. If a participant is under 18 years
Explosive chemicals
old, the parent/guardian signature is required.
Radioactive materials
Compressed gas (including, but not limited to CO
)
2
Hazardous substances or devices (including, but not limited
to BB guns, potato cannons, paint ball guns)
High voltage equipment
Lasers (any strength)
Ionizing radiation X-rays or nuclear energy
Check appropriate box:
I have read the above boxes, and my project does not involve any of the above materials or human
subjects.
My project involves Human Subjects and Form C is attached with all signed copies from subjects.
My research plan needs a designated supervising adult and Form D is attached.
(Non-pathogenic microorganisms and other safety issues. See Regulation section.)
Required Signatures
Student(s) _____________________________________________________________________________________
Teacher _______________________________________________________________________________________
Parent/Guardian ________________________________________________________________________________
Date _________________________________________________________________________________________
Please return to your local Regional Safety Review Committee for approval prior to experimentation.
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