Regulated 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.

This form MUST be displayed with your project; Responses must be on the form

Student’s Name   ______________________________________________________________

Title of Project     ______________________________________________________________

To be completed by the Supervising Adult in the Setting (NOT the Student) after experimentations: (Responses must remain on the form as it is required to be displayed at student’s project booth.)

The Student conducted research at my work site:

                To use the equipment                                                   to perform experiment(s)/conduct research

How did the student get the idea for her/his project?

(e.g. Was the project assigned, picked from a list, an original student idea, etc.)

 

 

 

Have you reviewed the ISEF rules relevant to this project?

                Yes                                         No

Did the student work on the project as a part of a research group?

                Yes                                         No

     If yes, how large was the group and what kind of research group was it (students, group of adult researches, ect.)

 

 

 

 

What specific procedures or equipment did the student actually use for the project.

    Please list and describe. (Do not list procedures student only observed.)

 

 

 

 

 

 

How independent or creative was the student’s work?

 

 

 

 

 

 

Student research projects dealing with human subjects, vertebrates animals or potentially hazardous biological agents require review and approval by an institutional regulatory board (IRB/IACUC/IBC).  Copy of approval(s) must be attached, if applicable.

 

____________________________       ____________________________  __________________________

Supervising Adult’s Printed Name         Signature                                                   Title

 

________________________________________________________  ____________________________

Institution                                                                                                                   Date Signed

 

________________________________________________________   ____________________________

Address                                                                                                                         Email/Phone