Qualified Scientist Student Questionnaire Template
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1Qualified Scientist Form (2)
May be required for research involving human participants, vertebrate animals, potentially hazardous biological agents, and
DEA-controlled substances. Must be completed and signed before the start of student experimentation.
Student’s Name(s)
Title of Project
To be completed by the Qualified Scientist:
Scientist Name:
Educational Background:
Degree(s):
Experience/Training as relates to the student’s area of research:
Position:
Institution:
Address:
Email/Phone:
o
o
1) Have you reviewed the Intel ISEF rules relevant to this project?
Yes
No
2. Will any of the following be used?
a. Human participants
o
Yes
o
No
b. Vertebrate animals
o
Yes
o
No
c. Potentially hazardous biological agents (microorganisms, rDNA and tissues,
o
o
including blood and blood products)
Yes
No
o
o
d. DEA-controlled substances
Yes
No
3. Was this study a sub-set of a larger study?
o
Yes
o
No
o
o
4. Will you directly supervise the student?
Yes
No
a.
If no, who will directly supervise and serve as the Designated Supervisor?
b. Experience/Training of the Designated Supervisor:
To be completed by the Designated Supervisor
To be completed by the Qualified Scientist:
when the Qualified Scientist cannot directly supervise.
I certify that I have reviewed and approved the Research Plan/
Project Summary prior to the start of the experimentation. If the
I certify that I have reviewed the Research Plan/Project Summary
student or Designated Supervisor is not trained in the necessary
and have been trained in the techniques to be used by this
procedures, I will ensure her/his training. I will provide advice and
student, and I will provide direct supervision.
supervision during the research. I have a working knowledge of
the techniques to be used by the student in the Research Plan/
Project Summary. I understand that a Designated Supervisor is
Designated Supervisor’s Printed Name
required when the student is not conducting experimentation
under my direct supervision.
Signature
Date of Approval
Qualified Scientist’s Printed Name
Signature
Date of Approval
Phone
Email
Page 34
International Rules: Guidelines for Science and Engineering Fairs 2017 – 2018,
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