Regulated Research Institutional / Industrial Setting Form
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1Regulated Research Institutional/Industrial Setting Form (1C)
This form must be completed AFTER experimentation by the adult supervising the student research conducted
in a regulated research institution, industrial setting or any work site other than home, school or field.
Student’s Name(s)
Title of Project
To be completed by the Supervising Adult in the Setting (NOT the Student(s)) after experimentation:
(Responses must remain on the form as it is required to be displayed at student’s project booth.)
The student(s) conducted research at my work site:
1.
Did you or your proxy (e.g. graduate student, postdoc, employee) mentor or provide
substantial guidance to the student researcher?
o Yes
o No
a.
If no, describe your and/or your institution’s role with the student researcher and
his/her project (e.g. supervised use of equipment on site without ongoing mentorship
and sign below.
b.
If yes, complete questions 2 –5.
2.
Is the student’s research project a subset of your ongoing research or work?
o Yes
o No
Use questions 3, 4 and 5 to detail how the student’s project was similar and/or
different from ongoing research or work at your site.
3.
Describe the independence and creativity with which the student:
a.
developed the hypotheses or engineering goals for her/her research project
b.
designed the methodology for his/her research project
c.
analyzed and interpreted data
4.
Detail the student’s role in conducting the research (e.g. data collection, specific procedures
performed). Differentiate what the student observed and what the student actually did.
5.
Did the student(s) work on the project as part of a group?
o Yes
o No
If yes, how many individuals were in the group and who were they (e.g. high school
students, graduate students, faculty, professional researchers)?
I attest that the student has conducted the work as indicated above and that any required review and approval by
institutional regulatory board (IRB/IACUC/IBC) has been obtained. Copies are attached if applicable.
I further acknowledge that the student will be presenting this work publicly in competition and I have communicated with
the student research regarding any requirements for my review and/or restrictions of what is publicized.
Supervising Adult’s Printed Name
Signature
Title
Institution
Date Signed (must be after experi-
mentation)
Address
Email/Phone
International Rules: Guidelines for Science and Engineering Fairs 2017 – 2018
Page 33
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