Fort Worth Regional Science And Engineering Fair Checklist Form

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2014 Fort Worth Regional Science and Engineering Fair Checklist Form
Student name: (Last): _______________________________ (First): __________________________
County Name:________________________ Start Date:____________ End Date:________________
√ = Form Present/ Item Complete
X = Item(s) Missing or Incomplete
__ = n/a
Media Release Form (REQUIRED) ________________________________________________________________
Abstract & Certification (REQUIRED)
[ ]
Item 1
Header (Title, Finalist name, School, City, & State) _______________________________________
[ ]
Item 2
Abstract (Purpose, Method, Data, & Conclusion) __________________________________________
[ ]
Item 3
Category Box ______________________________________________________________________
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Item 4
Question 1 (if applicable)_____________________________________________________________
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Item 5
Questions 2-5 ______________________________________________________________________
[ ]
Item 6
Student’s Signature and Date _________________________________________________________
Form 1: Checklist for Adult Sponsor (REQUIRED)
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Item 1
Student’s name, project title __________________________________________________________
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Item 2
Question 1-3  ____________________________________________________________________
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Item 3
Question 4, if applicable _____________________________________________________________
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Item 4
Question 5, first 4; last two if applicable ________________________________________________
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Item 5
Question 6, if applicable _____________________________________________________________
 Humans
 Vertebrate Animals
 Pot. Haz. Bio. Agts
Haz. Chem./Devices
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Item 6
Adult Sponsor, Sig, Date (Before Experiment), etc. _______________________________________
Form 1A: Student Checklist (REQUIRED)
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Item 1
Question 1-4 completed ______________________________________________________________
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Item 2
Question 5, Yes or No _______________________________________________________________
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Item 3
If Yes, ensure previous info (Abstract,
Form 1A, Res. Plan, Form 7) is attached ________________________________________________
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Item 4
Question 6, especially Actual start/end dates _____________________________________________
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Item 5
Question 7 at least one box ___________________________________________________________
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Item 6
Question 8 (if applicable) ____________________________________________________________
Research Plan (REQUIRED)
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Item 1
A. Question Addressed ______________________________________________________________
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Item 2
B. Hypothesis/Problem/Engineering Goals _______________________________________________
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Item 3
C. Detail Description of Method of Procedures ___________________________________________
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Item 4
D. Bibliography (At last 5 References) _________________________________________________
Form 1B: Approval form (REQUIRED)
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Item 1
2 boxes, Blanks filled in, date Before Experiment ________________________________________
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Item 2a
Approved Before Experiment ________________________________________________________
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Item 2b
Approved After Experiment _________________________________________________________
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Item 3
Approval by Regional SRC chair After Experiment _______________________________________
Form 1C: Regulated Research Institutional/Industrial Setting Form
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Item 1
Student Name and Project Title ________________________________________________________
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Item 2
Box “A” / “B” (Completed by Scientist after Exp.) ________________________________________
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Item 3
Questions 1- 4 _____________________________________________________________________
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Item 4
Scientist Name, Sig, Title, Institution, etc. ______________________________________________

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