Student Entry Form – SASEF

Due Feb 28!!! One form per student!

Mail completed SASEF and ISEF forms to SASEF,
2506 E.J. Chapman Drive, Knoxville, TN 37996-4531
Enclose entry fee (per student) $10/$20/$30* (please circle amount)
* $10 if received before Feb 15, $20 Feb 15-Feb 28, $30 Feb 28-Mar 12
Please enter this information in MS Word (not handwritten!)

Name__________________________________________________________________

Date of Birth______________________ School Grade _________M/F_____________

Preferred First Name on Name Tag______________________________________________

Street Address/P.O. Box___________________________________________________

City, State and Zip Code_______________________________________County: ______________

Home Phone______________________________E-mail ________________________

Parent/Guardian Name ___________________________________________________

Parent/Guardian Phone (home)_____________________cell_____________________

School Attended (or Homeshool)_________________________________________________

School Address__________________________________________________________

Project Title_____________________________________________________________

________________________________________________________________________

Is this a team project*? Y N If yes, name of teammate _______________________

* Senior division – only teams of 2 allowed Junior division – team of 2-3 allowed

Date on which I began research:____________ Date research was completed ________________

Is this project a continuation of last year’s project? Yes ______ No_____________

I conducted my research (please check one): At home ___ At School: ___

Other (specify) _________________________________

Science Teacher (First and Last Name) ______________________________________

Science Teacher’s e- mail _________________________________________________

My project involves (and I have included the required paperwork):
___ Vertebrate animals ___ Controlled substances
___ Firearms ___ Human Subjects
___ Radiation ___ Radioactive Materials
___ Tissues (including blood)
___ Hazardous tools or equipment or exposed electrical conductors carrying electricity
My project display requires electricity: ___ Yes ___ No
My exhibit is: ___ Table-top ___ Floor

Category for your project (please choose only one*):

___ Animal Science ___ Behavioral & Social Science
___ Biochemistry ___ Cellular & Molecular Biology
___ Chemistry ___ Computer Science
___ Earth & Planetary Science ___ Engineering: Electrical & Mechanical
___ Engineering: Materials & Bioengineering ___ Energy & Transportation
___ Environmental Management ___ Environmental Science
___ Mathematical Sciences ___ Medicine & Health Sciences
___ Microbiology ___ Physics & Astronomy
___ Plant Sciences

*Once your project has been selected and approved, you are not allowed to change categories so be sure
that you have selected the one best suited to your research project.

STUDENT READ and SIGN: I have read the rules of the Southern Appalachian Science and
Engineering Fair and have followed them since the beginning of my project, and I will continue to
follow them until my participation in the competition is completed. All help that I received from others
is clearly described in my report or on my exhibit. I have reviewed the safety and environmental risks of
my project with my science teacher. I will leave my entire exhibit on display until the conclusion of the
Awards Ceremony, and I will remove immediately after the ceremony.

STUDENT SIGNATURE: _______________________________DATE_____________

PARENT/GUARDIAN READ AND SIGN: I have read the rules of the Southern Appalachian Science
and Engineering Fair and confirm that my child has abided and will continue to abide by these rules. I
understand that the exhibit area will be open to the public and that neither the SASEF staff nor the fair
sponsors can be responsible for the loss or theft of any part of the exhibit.

PARENT/GUARDIAN SIGNATURE: ____________________DATE______________

TEACHER READ AND SIGN: I have read the rules of the Southern Appalachian Science and
Engineering Fair and confirm that my student has abided and will continue to abide by these rules. I
approve this project for participation in the SASEF.

TEACHER SIGNATURE _______________________________DATE______________