Fillable Qualiied Scientist Form (2) (Microsoft)

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Qualiied Scientist Form (2) (Microsoft)

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International Rules: Guidelines for Science and Engineering Fairs 2021–2022, societyforscience.org/ISEF Page 37
Qualiied Scientist Form (2)
May be required for research involving human participants, vertebrate animals, potentially hazardous
biological agents, and hazardous substances and devices. Must be completed and signed before the start
of student experimentation.
To be completed by the Designated Supervisor
when the Qualiied Scientist cannot directly
supervise.
I certify that I have reviewed the Research Plan/Project
Summary 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 (mm/dd/yy)
Phone Email
To be completed by the Qualiied Scientist:
I certify that I have reviewed and approved the Research Plan/
Project Summary 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/Project Summary. I understand
that a Designated Supervisor is required when the student is
not conducting experimentation under my direct supervision.
Qualiied Scientist’s Printed Name
Signature Date of Approval (mm/dd/yy)
Student’s Name(s)
Title of Project
To be completed by the Qualiied Scientist:
Scientist Name:
Educational Background: Degree(s):
Experience/Training as relates to the student’s area of research:
Position/Institution: Email/Phone:
1. Have you reviewed the ISEF rules relevant to this project and the science Yes No
fair ethics statement relevant to this project?
2. Will any of the following be used?
a. Human participants Yes No
b. Vertebrate animals Yes No
c. Potentially hazardous biological agents (microorganisms, rDNA and Yes No
tissues, including blood and blood products)
d. Hazardous substances and devices Yes No
3. Will this study be a sub-set of a larger study? Yes No
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:
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Qualiied Scientist Form (2) (Microsoft)

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Completed 3 August 2021

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