Bacteria Form 4 (4-8)

Grades 4-8

Required for all projects involving bacteria (regardless of source) except for baker’s or brewer’s yeast.

NOTE: Kansas State Science and Engineering Fair Review Committee (KSSEFRC) approval required before experiment begins.

To obtain SRC approval, fax this completed form directly to 620-583-8222.

Student's Name _____________________________________________________________________________

Title of Project ______________________________________________________________________________

To be completed by Student Researcher and/or Adult Sponsor (answer on attached page if needed):

1. Briefly describe the overall design or plan of this study.

2. Describe specifically how the bacteria will be used or how they will be collected from the environment. If

bacteria are to be purchased, identify the source and the specific type of bacteria.

3. Identify who will supervise the student and the specific location(s) at which the bacteria will be used. Bacteria may not be cultured (grown) in a home environment, only in an appropriate space at school or in a lab.

4. Identify procedures to minimize risk, including the method of disposal when the study is done. Acceptable methods of disposal include sterilization (autoclaving) and appropriate disinfection with

bleach.

All Signatures Required Prior to Start of Research Project

______________________________ ______________________________ ____________________

Student Researcher's Printed Name Signature Date Signed

______________________________ ______________________________ ____________________

Science Teacher's Printed Name Signature Date Signed

______________________________ ______________________________ ____________________

Parent or Guardian's Printed Name Signature Date Signed

STOP – Once the form is completed this far, send via FAX to the SRC (816-501-4802). After approval, the completed form will be returned (be sure to include return contact info below) for inclusion in the project.

Approved by Kansas State Science and Engineering Fair Review Committee (Fax to 620-583-8222):

__________________________________ ______________________________ _____________

SRC Chair’s Printed Name Signature Date of Approval

 2009-2010 Send notification of approval to: ______________________________________________________________