Fillable 2014 Intl Interactiverules (Southeastern Louisiana University)

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2014 Intl Interactiverules (Southeastern Louisiana University)

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  • 111 check-boxes
  • 176 other fields

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International Rules: Guidelines for Science and Engineering Fairs 2013–2014, www.societyforscience.org/isef Page 31
Checklist for Adult Sponsor (1)
This completed form is required for ALL projects.
Adult Sponsor’s Printed Name Signature Date of Review
Phone Email
To be completed by the Adult Sponsor in collaboration with the student researcher(s):
Student’s Name(s):
Project Title:
1) o I have reviewed the Intel ISEF Rules and Guidelines.
2) o I have reviewed the student’s completed Student Checklist (1A) and Research Plan.
3) o I have worked with the student and we have discussed the possible risks involved in the project.
4) o The project involves one or more of the following and requires prior approval by an SRC, IRB, IACUC or IBC:
o Humans Potentially Hazardous Biological Agents
o Vertebrate Animals o Microorganisms o rDNA o Tissues
5) o Items to be completed for ALL PROJECTS
o Adult Sponsor Checklist (1) o Research Plan
o Student Checklist (1A) o Approval Form (1B)
o Regulated Research Institutional/Industrial Setting Form (1C) (when applicable after completed experiment)
o Continuation/Research Progression Form (7) (when applicable)
6) Additional forms required if the project includes the use of one or more of the following (check all that
apply):
o Humans (Requires prior approval by an Institutional Review Board (IRB); see full text of the rules.)
o Human Participants Form (4) or appropriate Institutional IRB documentation
o Sample of Informed Consent Form (when applicable and/or required by the IRB)
o QualiedScientistForm(2)(whenapplicableand/orrequiredbytheIRB)
o Vertebrate Animals (Requires prior approval, see full text of the rules.)
o VertebrateAnimalForm(5A)—forprojectsconductedinaschool/home/eldresearchsite(SRCprior
approval required.)
o Vertebrate Animal Form (5B)—for projects conducted at a Regulated Research Institution. (Institutional
Animal Care and Use Committee (IACUC) approval required prior experimentation.)
o QualiedScientistForm(2)(Requiredforallvertebrateanimalprojectsataregulatedresearchsiteor
when applicable)
o Potentially Hazardous Biological Agents (Requires prior approval by SRC, IACUC or Institutional Biosafety
Committee (IBC), see full text of the rules.)
o Potentially Hazardous Biological Agents Risk Assessment Form (6A)
o Human and Vertebrate Animal Tissue Form (6B)—to be completed in addition to Form 6A when project
involvestheuseoffreshorfrozentissue,primarycellcultures,blood,bloodproductsandbodyuids.
o QualiedScientistForm(2)(whenapplicable)
o Risk Assessment Form (3) required for projects involving protists, archae and similar microorganisms, for
projects using manure for composting, fuel production or other non-culturing experiments, for projects
using color change coliform water test kits, microbial fuel cells, and for projects involving decomposing
vertebrate organisms
o Hazardous Chemicals, Activities and Devices (No prior approval required, see full text of the rules.)
o Risk Assessment Form (3)
o QualiedScientistForm(2)(requiredforprojectsinvolvingDEA-controlledsubstancesorwhen
applicable)
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Page 32 International Rules: Guidelines for Science and Engineering Fairs 2013–2014, www.societyforscience.org/isef
Student Checklist (1A)
This form is required for ALL projects.
1) a. Student/Team Leader: Grade:
Email: Phone:
b. Team Member: c. Team Member:
2) Title of Project:
3) School: School Phone:
School Address:
4) Adult Sponsor: Phone/Email:
5) Is this a continuation/progression from a previous year? o Yes o No
If Yes:
a) Attach the previous year’s o Abstract and o Research Plan
b) Explain how this project is new and different from previous years on o Continuation/Research Progression
Form (7)
6) This year’s laboratory experiment/data collection: (must be stated (mm/dd/yy))
Start Date: (mm/dd/yy) End Date: (mm/dd/yy)
7) Where will you conduct your experimentation? (check all that apply)
o Research Institution o School o Field o Home o Other:________________________
8) List name and address of all non-school work site(s):
Name:
Address:
Phone:
9) Complete a Research Plan following the Research Plan instructions and attach to this form.
10) An abstract is required for all projects after experimentation.
International Rules: Guidelines for Science and Engineering Fairs 2013–2014, www.societyforscience.org/isef Page 33
Research Plan Instructions
A complete research plan is required and must accompany Checklist for Student (1A)
Provide a typed research plan and attach to Student Checklist (1A). Please include your name on each page.
The research plan for ALL projects is to include the following:
A. Question or Problem being addressed
B. Goals/Expected Outcomes/Hypotheses
C. Description in detail of method or procedures (The following are important and key items that should be included
when formulating ANY AND ALL research plans.)
• Procedures: Detail all procedures and experimental design to be used for data collection
• Risk and Safety: Identify any potential risks and safety precautions to be taken.
• Data Analysis: Describe the procedures you will use to analyze the data/results that answer research questions or
hypotheses
D. Bibliography:Listatleastve(5)majorreferences(e.g.sciencejournalarticles,books,internetsites)fromyour
literature review. If you plan to use vertebrate animals, one of these references must be an animal care reference.
o Choose one style and use it consistently to reference the literature used in the research plan
o Guidelines can be found in the Student Handbook
Items 1–4 below are subject-specic guidelines for additional items to be included in your research plan as
applicable:
1. Human participants research:
• Participants. Describe who will participate in your study (age range, gender, racial/ethnic composition). Identify any
vulnerable populations (minors, pregnant women, prisoners, mentally disabled or economically disadvantaged).
• Recruitment. Wherewillyoundyourparticipants?Howwilltheybeinvitedtoparticipate?
• Methods. What will participants be asked to do? Will you use any surveys, questionnaires or tests? What is the
frequency and length of time involved for each subject?
• Risk Assessment
o Risks. What are the risks or potential discomforts (physical, psychological, time involved, social, legal, etc.) to
participants? How will you minimize the risks?
o Benets.Listanybenetstosocietyoreachparticipant.
• Protection of Privacy. Willanyidentiableinformation(e.g.,names,telephonenumbers,birthdates,email
addresses)becollected?Willdatabecondentialoranonymous?Ifanonymous,describehowthedatawillbe
collectedanonymously.Ifnotanonymous,whatproceduresareinplaceforsafeguardingcondentiality?Wherewill
the data be stored? Who will have access to the data? What will you do with the data at the end of the study?
• Informed Consent Process. Describe how you will inform participants about the purpose of the study, what they
will be asked to do, that their participation is voluntary and they have the right to stop at any time.
2. Vertebrate animal research:
• BrieydiscusspotentialALTERNATIVEStovertebrateanimaluseandpresentadetailedjusticationforuseof
vertebrate animals
• Explain potential impact or contribution this research may have
• Detail all procedures to be used
o Include methods used to minimize potential discomfort, distress, pain and injury to the animals during the
course of experimentation
o Detailed chemical concentrations and drug dosages
• Detail animal numbers, species, strain, sex, age, source, etc.
o Includejusticationofthenumbersplannedfortheresearch
• Describe housing and oversight of daily care
• Discuss disposition of the animals at the termination of the study
3. Potentially Hazardous Biological Agents:
• Describe Biosafety Level Assessment process and resultant BSL determination
• Givesourceofagent,sourceofspeciccellline,etc.
• Detail safety precautions
• Discuss methods of disposal
4. Hazardous Chemicals, Activities & Devices:
• Describe Risk Assessment process and results
• Detail chemical concentrations and drug dosages
• Describe safety precautions and procedures to minimize risk
• Discuss methods of disposal
Page 34 International Rules: Guidelines for Science and Engineering Fairs 2013–2014, www.societyforscience.org/isef
Approval Form (1B)
A completed form is required for each student, including all team members.
a) Required for projects that need prior SRC/IRB
approval BEFORE experimentation
(humans, vertebrates or potentially hazardous
biological agents)
The SRC/IRB has carefully studied this project’s Research
Plan and all the required forms are included. My signature
indicates approval of the Research Plan before the
student begins experimentation.
SRC/IRB Chair’s Printed Name
Signature Date of Approval (mm/dd/yy)
(Must be prior to experimentation.)
3) Final Intel ISEF Afliated Fair SRC Approval (Required for ALL Projects)
b) Required for research conducted at all Regulated
Research Institutions with no prior fair SRC/IRB
approval.
This project was conducted at a regulated research
institution (not home or high school, etc.), was
reviewed and approved by the proper institutional
board before experimentation and complies with the
Intel ISEF Rules. Attach (1C) and required institutional
approvals (e.g. IACUC, IRB).
SRC Chair’s Printed Name
Signature Date of Approval (mm/dd/yy)
SRC Approval After Experimentation and Before Competition at Regional/State/National Fair
I certify that this project adheres to the approved Research Plan and complies with all Intel ISEF Rules.
Regional SRC Chair’s Printed Name Signature Date of Approval
State/National SRC Chair’s Printed Name Signature Date of Approval
(where applicable)
1) To Be Completed by Student and Parent
a) Student Acknowledgment:
• I understand the risks and possible dangers to me of the proposed research plan.
• I have read the Intel ISEF Rules and Guidelines and will adhere to all International Rules when conducting this
research.
• I have read and will abide by the following Ethics statement
Scientic fraud and misconduct are not condoned at any level of research or competition. Such practices include
plagiarism, forgery, use or presentation of other researcher’s work as one’s own, and fabrication of data.
Fraudulent projects will fail to qualify for competition in afliated fairs and the Intel ISEF.
Student’s Printed Name Signature Date Acknowledged (mm/dd/yy)
(Must be prior to experimentation.)
b) Parent/Guardian Approval: I have read and understand the risks and possible dangers involved in the Research
Plan. I consent to my child participating in this research.
Parent/Guardian’s Printed Name Signature Date Acknowledged (mm/dd/yy)
(Must be prior to experimentation.)
2) To be completed by the local or afliated Fair SRC
(Required for projects requiring prior SRC/IRB APPROVAL. Sign 2a or 2b as appropriate.)
OR
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International Rules: Guidelines for Science and Engineering Fairs 2013–2014, www.societyforscience.org/isef Page 35
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 eld.
This form MUST be displayed with your project; responses must be on the form.
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:
a) o to use the equipment b) o to perform experiment(s)/conduct research
1) Is this research a subset of your work? o Yes o No
2) Have you reviewed the Intel ISEF rules relevant to this project? o Yes o No
3) 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.)
4) Did the student(s) work on the project as a part of a research group? o Yes o No
If yes, how large was the group and what kind of research group was it (students, group of adult researchers, etc.)
5) Whatspecicproceduresorequipmentdidthestudent(s)actuallyusefortheproject?
Please list and describe. (Do not list procedures student only observed.)
6) How independent or creative was the student’s/students’ work?
Student research projects dealing with human participants, vertebrate 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 (must be after experimentation)
Address Email/Phone
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Page 36 International Rules: Guidelines for Science and Engineering Fairs 2013–2014, www.societyforscience.org/isef
Qualied 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.
To be completed by the Designated Supervisor
when the Qualied Scientist cannot directly
supervise.
I certify that I have reviewed the Research Plan and have
been trained in the techniques to be used by this student,
and I will provide direct supervision.
Designated Supervisor’s Printed Name
Signature Date of Approval
Phone Email
To be completed by the Qualied Scientist:
I certify that I have reviewed and approved the Research
Plan prior to the start of the experimentation. If the
student or Designated Supervisor is not trained in the
necessary procedures, I will ensure her/his training. I will
provide advice and supervision during the research. I
have a working knowledge of the techniques to be used
by the student in the Research Plan. I understand that a
Designated Supervisor is required when the student is not
conducting experimentation under my direct supervision.
QualiedScientist’sPrintedName 
Signature Date of Approval
Student’s Name(s)
Title of Project
To be completed by the Qualied Scientist:
Scientist Name:
Educational Background: Degree(s):
Experience/Training as relates to the student’s area of research:
Position: Institution:
Address: Email/Phone:
1) Have you reviewed the Intel ISEF rules relevant to this project? o Yes o 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,
including blood and blood products) o Yes o No
d) DEA-controlled substances o Yes o No
3) Was this study a sub-set of a larger study? o Yes o No
4) Will you directly supervise the student? o Yes o No
a) If no, who will directly supervise and serve as the Designated Supervisor?
b) Experience/Training of the Designated Supervisor:
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International Rules: Guidelines for Science and Engineering Fairs 2013–2014, www.societyforscience.org/isef Page 37
Risk Assessment Form (3)
Required for projects using hazardous chemicals, activities or devices and microorganisms exempt
from pre-approval. Must be completed before experimentation.
Student’s Name(s)
Title of Project
To be completed by the Student Researcher(s) in collaboration with Designated Supervisor/Qualied
Scientist: (All questions must be answered; additional page(s) may be attached.)
1. List/identify microorganisms exempt from pre-approval (see Potentially Hazardous Biological Agent rules),
and all hazardous chemicals, activities, or devices that will be used.
2. Identify and assess the risks involved in this project.
3. Describe the safety precautions and procedures that will be used to reduce the risks.
4. Describe the disposal procedures that will be used (when applicable).
5. List the source(s) of safety information.
To be completed and signed by the Designated Supervisor (or Qualied Scientist, when applicable):
I agree with the risk assessment and safety precautions and procedures described above. I certify that I have reviewed the
Research Plan and will provide direct supervision.
Designated Supervisor’s Printed Name Signature Date of Review (mm/dd/yy)
Position & Institution Phone or email contact information
Experience/Training as relates to the student’s area of research
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Page 38 International Rules: Guidelines for Science and Engineering Fairs 2013–2014, www.societyforscience.org/isef
Human Participants Form (4)
Required for all research involving human participants not at a Regulated Research Institution. If at a Regulated Research Institution,
use institutional approval forms for documentation of prior review and approval.
(IRB approval required before experimentation.)
Student’s Name(s) Title of Project
Adult Sponsor Contact Phone/Email
Must be completed by Student Researcher(s) in collaboration with the Adult Sponsor/Designated Supervisor/Qualied
Scientist:
1. o I have submitted my Research Plan which addresses ALL areas indicated in the Human Participants Section of the
Research Plan Instructions.
2. o I have attached any surveys or questionnaires I will be using in my project.
o Any published instrument(s) used was /were legally obtained.
3. o I have attached an informed consent that I would use if required by the IRB.
4. o Yes o No AreyouworkingwithaQualiedScientist?Ifyes,attachtheQualiedScientistForm2
Must be completed by Institutional Review Board (IRB) after review of the research plan. The submitted
Research Plan must address all areas indicated on the Human Participants section of the Research Plan Instructions.
Check one of the following:
o Research project requires revisions and is NOT approved at this time. IRB will attach document indicating concerns
and/or requested revisions.
o Research project is Approved with the following conditions below: (All 5 must be answered)
1. Risk Level (check one) : o Minimal Risk o More than Minimal Risk
2. QualiedScientist(QS)Required: o Yes o No
3. Written Minor Assent required for minor participants:
o Yes o No o Not applicable (No minors in this study)
4. Written Parental Permission required for minor participants:
o Yes o No o Not applicable (No minors in this study)
5. Written Informed Consent required for participants 18 years or older:
o Yes o No o Not applicable (No participants 18 yrs or older in this study)
IRB SIGNATURES (All 3 signatures required) None of these individuals may be the adult sponsor, designated supervisor,
qualiedscientistorrelatedto(e.g.,mother,fatherof)thestudent(conictofinterest).
I attest that I have reviewed the student’s project and agree with the above IRB determinations.
Medical or Mental Health Professional (a psychologist, medical doctor, licensed social worker, licensed clinical professional
counselor, physician’s assistant, or registered nurse)
School Administrator
Printed Name Degree/Professional License
Signature Date of Approval (Must be prior to experimentation.)
Printed Name Degree
Signature Date of Approval (Must be prior to experimentation.)
Educator
Printed Name Degree
Signature Date of Approval (Must be prior to experimentation.)
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International Rules: Guidelines for Science and Engineering Fairs 2013–2014, www.societyforscience.org/isef Page 39
Human Informed Consent Form
Instructions to the Student Researcher(s): An informed consent/assent/permission form should be developed in
consultationwiththeAdultSponsor,DesignatedSupervisororQualiedScientist.
This form is used to provide information to the research participant (or parent/guardian) and to document written
informed consent, minor assent, and/or parental permission.
• When written documentation is required, the researcher keeps the original, signed form.
• Students may use this sample form or may copy ALL elements of it into a new document.
If the form is serving to document parental permission, a copy of any survey or questionnaire must be attached.
Student Researcher(s):
Title of Project:
I am asking for your voluntary participation in my science fair project. Please read the following information about the
project. If you would like to participate, please sign in the appropriate box below.
Purpose of the project:
If you participate, you will be asked to:
Time required for participation:
Potential Risks of Study:
Benets:
Howcondentialitywillbemaintained:
If you have any questions about this study, feel free to contact:
AdultSponsor:__________________________Phone/email:____________________________________________
Voluntary Participation:
Participation in this study is completely voluntary. If you decide not to participate there will not be any negative
consequences. Please be aware that if you decide to participate, you may stop participating at any time and you may
decidenottoansweranyspecicquestion.
By signing this form I am attesting that I have read and understand the information above and I freely give my
consent/assent to participate or permission for my child to participate.
Adult Informed Consent or Minor Assent Date Reviewed & Signed:
Printed Name of Research Participant: Signature:
Parental/Guardian Permission (if applicable) Date Reviewed & Signed:
Parent/Guardian Printed Name: Signature:
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Page 40 International Rules: Guidelines for Science and Engineering Fairs 2013–2014, www.societyforscience.org/isef
Vertebrate Animal Form (5A)
Required for all research involving vertebrate animals that is conducted in a school/home/eld research site.
(SRC approval required before experimentation.)
Student’s Name(s)
Title of Project
To be completed by Student Researcher:
1. Common name (or Genus, species) and number of animals used.
2. Describe completely the housing and husbandry to be provided. Include the cage/pen size, number of animals per
cage, environment, bedding, type of food, frequency of food and water, how often animal is observed, etc.
3. What will happen to the animals after experimentation?
4. Attach a copy of wildlife licenses or approval forms, as applicable
5. The Intel ISEF Vertebrate Animal Rules require that any death, illness or unexpected weight loss be investigated and
documentedbyaletterfromthequaliedscientist,designatedsupervisororaveterinarian.Ifapplicable,attachthis
letter with this form when submitting your paperwork to the SRC prior to competition.
To be completed by Local or Afliate Fair Scientic Review Committee (SRC) BEFORE experimentation
Level of Supervision Required for agricultural, behavioral or nutritional studies:
o Designated Supervisor REQUIRED. Please have applicable person sign below.
o Veterinarian and Designated Supervisor REQUIRED. Please have applicable persons sign below.
o Veterinarian,DesignatedSupervisorandQualiedScientistREQUIRED.Pleasehaveapplicablepersonssignbelowandhavethe
QualiedScientistcompleteForm(2).
TheSRChascarefullyreviewedthisstudyandndsitisanappropriatestudythatmaybeconductedinanon-regulatedresearchsite.
Local or Afliate Fair SRC Pre-Approval Signature:
SRC Chair Printed Name Signature Date of Approval (must be prior to
experimentation) (mm/dd/yy)
Printed Name Email/Phone Printed Name Email/Phone
Signature Date of Approval Signature Date of Approval
To be completed by Veterinarian:
o I certify that I have reviewed this research and animal
husbandry with the student before the start of
experimentation.
o I certify that I have approved the use and dosages of
prescription drugs and/or nutritional supplements.
o I certify that I will provide veterinary medical and nursing
care in case of illness or emergency.
To be completed by Designated Supervisor or
Qualied Scientist when applicable:
o I certify that I have reviewed this research and animal
husbandry with the student before the start of
experimentation and I accept primary responsibility for the
care and handling of the animals in this project.
o I certify that I will directly supervise the experiment.
International Rules: Guidelines for Science and Engineering Fairs 2013–2014, www.societyforscience.org/isef Page 41
Student’s Name(s)
Title of Project
Title and Protocol Number of IACUC Approved Project
To be completed by Qualied Scientist or Principal Investigator:
1. Species of animals used: Number of animals used:
2. Describe, in detail, the role of the student in this project: animal procedures and related equipment that were
involved, oversight provided and safety precautions employed. (Attach extra pages if necessary.)
3.Wasthereanyweightlossordeathofanyanimal?Ifyes,attachaletterobtainedfromthequaliedscientist,
designated supervisor or a veterinarian documenting the situation and the results of the investigation.
4. Does the student’s project also involve the use of tissues?
p No
p Yes, Be sure to complete Forms 6A and 6B
5. What laboratory training, including dates, was provided to the student?
6. Attach a copy of the Regulated Research Institution IACUC Approval. AletterfromtheQualiedScientistor
PrincipalInvestigatorisnotsufcient.
Vertebrate Animal Form (5B)
Required for all research involving vertebrate animals that is conducted in at a Regulated Research Institution.
(IACUC approval required before experimentation.)
Qualied Scientist/Principal Investigator
Printed Name
Signature Date
Page 42 International Rules: Guidelines for Science and Engineering Fairs 2013–2014, www.societyforscience.org/isef
Student’s Name(s)
Title of Project
To be completed by Student Researcher(s) in collaboration with Qualied Scientist/Designated Supervisor:
(All questions are applicable and must be answered; additional page(s) may be attached.)
1. Identify potentially hazardous biological agents to be used in this experiment. Include the source, quantity and the biosafety
level risk group of each microorganism.
2. Describe the site of experimentation including the level of biological containment.
3. Describe the procedures that will be used to minimize risk. (personal protective equip., hood type, etc.)
4. Whatnalbiosafetyleveldoyourecommendforthisprojectgiventheriskassessmentyouconducted?
5. Describe the method of disposal of all cultured materials and other potentially hazardous biological agents.
Potentially Hazardous Biological Agents Risk Assessment Form (6A)
Required for research involving microorganisms, rDNA, fresh/frozen tissue (including primary cell lines, human and
otherprimateestablishedcelllinesandtissuecultures),blood,bloodproductsandbodyuids.
SRC/IACUC/IBC approval required before experimentation.
To be completed by Local or Afliate Fair SRC: (Check all that apply.)
o The SRC has carefully studied this project’s Research Plan and the risk level assessment above prior to experimentation
and approves this study as a BSL-1 study, which must be conducted at a BSL-1 or above laboratory.
DateofSRCapproval(priortoexperimentation)_____________________
o The SRC has carefully studied this project’s Research Plan and the risk level assessment above prior to experimentation
and approves this study as a BSL-2 study, which must be conducted at a BSL-2 or above laboratory.
 DateofSRCapproval(priortoexperimentation)_____________________
o This project was conducted at a Research Institution and was reviewed and approved by the appropriate institutional
board (e.g. IACUC, IBC) before experimentation at a BSL-1 or BSL-2 laboratory and complies with the Intel ISEF rules. The
required institutional forms are attached.
 DateofSRCapproval(afterexperimentation)_____________________
o The Research Institution where this study was conducted does not require approval for this type of study. The student
has received proper training and the project complies with Intel ISEF rules. Attached is institutional documentation
certifying the above.
DateofSRCapproval_________________________________________
SRC Chair’s Printed Name Signature
To be completed by Qualied Scientist or Designated Supervisor
1. What training will the student receive for this project?
2. Do you concur with the biosafety information and recommendation provided by the student researcher above?
o Yes o No If no, please explain.
3. Experience/training of Designated Supervisor as it relates to the student’s area of research (if applicable)
QS/DS Printed Name Signature Date of Signature (mm/dd/yy)
International Rules: Guidelines for Science and Engineering Fairs 2013–2014, www.societyforscience.org/isef Page 43
Human and Vertebrate Animal Tissue Form (6B)
Required for research involving fresh/frozen tissue (including primary cell lines, human and other primate established cell lines
andtissuecultures),blood,bloodproductsandbodyuids.Iftheresearchinvolveslivingorganismspleaseensurethattheproper
human or animal forms are completed. All projects using any tissue listed above must also complete Form 6A.
Student’s Name(s)
Title of Project
To be completed by Student Researcher(s):
1. What vertebrate animal tissue will be used in this study? Check all that apply.
o Fresh or frozen tissue sample
o Fresh organ or other body part
o Blood
o Bodyuids
o Primary cell/tissue cultures
o Human or other primate established cell lines
2. Where will the above tissue(s) be obtained. If using an established cell line include source and catalog number.
3. If the tissue will be obtained from a vertebrate animal study conducted at a research institution attach a copy of the
IACUCcerticationwiththenameoftheresearchinstitution,thetitleofthestudy,theIACUCapprovalnumberand
date of IACUC approval.
To be completed by the Qualied Scientist or Designated Supervisor:
o I verify that the student will work solely with organs, tissues, cultures or cells that will be supplied to him/her by myself
orqualiedpersonnelfromthelaboratory;andthatifvertebrateanimalswereeuthanizedtheywereeuthanizedfora
purpose other than the student’s research.
AND/OR
o Icertifythattheblood,bloodproducts,tissuesorbodyuidsinthisprojectwillbehandledinaccordancewiththe
standards and guidance set forth in Occupational Safety and Health Act, 29CFR, Subpart Z, 1910.1030 - Blood Borne
Pathogens.
Printed Name Signature Date of Approval
(Must be prior to experimentation.)
Title Phone/Email
Institution
Page 44 International Rules: Guidelines for Science and Engineering Fairs 2013–2014, www.societyforscience.org/isef
Continuation/Research Progression Projects Form (7)
Required for projects that are a continuation/progression in the same eld of study as a previous project.
This form must be accompanied by the previous year’s abstract and Research Plan.
Student’s Name(s)
To be completed by Student Researcher:
List all components of the current project that make it new and different from previous research. The information must
be on the form; use an additional form for 2010–2011 and earlier projects.
Components
Current Research
Project
Previous Research
Project
1. Title
2012–2013
2011–2012
2. Change in
goal/purpose/
objective
2012–2013
2011–2012
3. Changes in
methodology
2012–2013
2011–2012
4. Variables
studied
2012–2013
2011–2012
5. Additional
changes
2012–2013
2011–2012
IherebycertifythattheaboveinformationiscorrectandthatthecurrentyearAbstract&Certicationand
projectdisplayboardproperlyreectworkdoneonlyinthecurrentyear.
Student’s Printed Name(s) Signature Date of Signature
Attached are:
o 2012–2013 Abstract and Research Plan o 2011–2012 Abstract
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2014 Intl Interactiverules (Southeastern Louisiana University)

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Completed 24 July 2020

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