Qualified Scientist Form (2) May be required for research involving human participants, vertebrate animals, potentially hazardous blological agents, and hazardous substances and devices. Must be completed and signed before the start of student experimentation. Student's Name(s) __Denite Sanit, Pama Taolrara, krirrim Pal Title of Project Tes lity ral eae werii) en Prporhes of pil and Plant _érowth ae To be completed by the Qualified Scienti Scientist Name:_Reborty MM - Davidl Educational Background: Degree(s): Experience/Training as relates to the student's area of research Position: Institution: Department oF Agetaud men Cai Address:_@anguy Sts Agdao DC Email/Phone: 1) Have you reviewed the intel ISEF rules relevant to this project? Eves ONo 2. Will any of the following be used? a. Human participants Oves No b. Vertebrate animals Dyes No ¢. Potentially hazardous biological agents (microorganisms, rDNA and tissues, including blood and blood products) Dyes No 4. Hazardous substances and devices Dyes fio 3. Will this study be a sub-set of a larger study? Bes = ONo 4. will you directly supervise the student? Bes flo a b. Experience/Training of the Designated Supervisor: no, who will directly supervise and serve as the Designated Supervisor? _Azenith pa ‘To be completed by the Qualified Scientist: | certify that | have reviewed and approved the Research Plan/ Project Summary prior to the start ofthe experimentation. Ifthe student or Designated Supervisor isnot trained in the necessary procedures, | will ensure her/his training, | wil provide advice and supervision during the research | have a working knowledge of the techniques to be used by the student in the Research Plan/ Project Summary. understand that a Designated Supervisor is. required when the student fs not conducting experimentation under my direct supervision, ‘To be completed by the Designated Supervisor ‘when the Qualified Scientist cannot directly supervise. | certify that | have reviewed the Research Plan/Project Summary ‘and have been trained in the techniques to be used by this ‘student, and I wil provide direct supervision, Ar en Designated Supervisor's Printed Name ROGERTD fet. __ DAVID =*<— Od [a fdeig _ Qualified Scientist's Printed Name Signature Date of Approval (mm/ddiyy) (CET et 13/201 cans aszrul> Sigratore Date of Approval (mm/adiyy) Phone Email International Rules: Guidelines for Science and Engineering Fairs 2016-2079, student.societyforsclence.org/intel lee? Page 35| Checklist for Adult Sponsor (1) This completed form is required for ALL projects. ‘To be completed by the Adult Sponsor in collaboration with the student researcher(s): Student's Name(s); Denise Gin Arabella Saniel, Kristine Jane Pal & Pamela Isabelle Tabirara Project Tite: The Fixating Abilly of Seaweed Extract in the Physiochemical Properties of So and Plant Grow 1. Ihave reviewed the Intel ISEF Rules and Guidelines. 2. | have reviewed the student's completed Student Checklist (1A) and Research Plan/Project Summary. 3. | haveworked with the student and we have discussed the possible risks involved in the project. 4. 11 The project involves one or more of the following and requires prior approval by an SRC, IRB, IACUC or IBC: Humans Potentially Hazardous Biological Agents Vertebrate Animals 1 Microorganisms © rDNA 0 Tissues 5. Tl htems to be completed for ALL PROJECTS Adult Sponsor Checklist (1) Research Plan/Project Summary Student Checklist (14) Approval Form (18) 1B Regulated Research insttutional/industrial Setting Form (1C) (when applicable; after completed experiment) 1 Continuation/Research Progression Form (7)(when applicable) nal forms required if the project includes the use of one or more ofthe following (check ll hat appiy Humans, including student designed inventons/prototypes. Requires prior approval by an institutional Review Board (IR); see full text of the rules) 1D. Human Participants Form () or appropriate Institutional IRB documentation 1D. Sample of Informed Consent Form (when applicable andlor required bythe RB) 1D. Qualiied Scientist Form (2) (when applicable and/or required by the IRB) Vertebrate Animals (Requires prior approval, see full text ofthe rules) Vertebrate Animal Form (5A)-for projects conducted in a school/home/tels esearch site (SRC prior approval required) Vertebrate Animal Form (58)~for projects conducted at a Regulated Research Institution. (Institutional Animal Care and Use Committee ACUC) approval required prior experimentation) Qualified Scientist Form (2) (Required forall vertebrate animal projects at a regulated research site or when applicable) Potentially Hazardous Biological Agents (Requires prior approval by SRC, IACUC or IBC, see full text of the rules.) 1 Potentially Hazardous Biological Agents Risk Assessment Form (6A) Human and Vertebrate Animal Tissue Form (68)-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 fluids. 1 Qualified Scientist Form (2) (when applicable) The following are exempt from prior review but require a Risk Assessment Form 3: projects involving protists, archae and similar microorganisms, for projects using manure for composting, fuel production or other non-culturing experiments, projects using color change coliform water test kits, microbial fuel cells, and projects involving decomposing vertebrate organisms. 11 Hazardous Chemicals, Activities and Devices (No SRC prior approval required, see full text ofthe rules) Risk Assessment Form (3) Qualified Scientist Form (2) (required for projects involving DEA-controlled substances or when applicable) Azenith Pal 09-19-14 ‘Adult Sponsors Printed Name Signature Date of Review (mm/adiyy) CMOS 0% 2¢ GI Phone Email Taternational Rules: Guidelines for Sclence and Engineering Fairs 2018-2079, student-socletyforsclence.org/intel-ise? Page 23[ Risk Assessment Form (3) Must be completed before experimentation. Student's Name(s) Denise Gin Arabella Saniel, Kristine Jane Pal & Pamela Isabelle Tabirara Title of Project The Nitrogen-fixing Analysis of Azolla (Azolla pinnata) and Hyacinth Bean (Lablab purpureus) Extracts To be completed by the Student Researcher(s) in collaboration with Designated Supervisor/Qualified Scientist: (All questions must be answered; additional page(s) may be attached.) 1. Listall hazardous chemicals, activities, or devices that will be used: identify microorganisms exempt from pre-approval (see Potentially Hazardous Biological Agent rules). None 2. Identify and assess the risks involved in this project. ‘The risk of contamination may occur when unwanted substance are inhaled, swallowed and come into contact with 3. Describe the safety precautions and procedures that willbe used to reduce the risks. Gloves, goggles and lab coats will be worn at all mes - Follow the methods that is planned in conducting the study - Listen to what the Research Consultant/Adviser says ~ When conducting the experiment make sure to have the Research Adviser to guide and help the experimentation 4, Describe the disposal procedures that willbe used (when applicable). - Organic waste or hazardous chemicals willbe stored in appropriate waste containers and will be disposed in the proper place 5, List the source(s) of safety information. ~ Research Ethics & Compliance - Research Data Management Toolkit - The Research Ethics Guidebook To be completed and signed by the Designated Supervisor (or Qualified Scientist, when applicable): agree with the risk assessment and safety precautions and procedures described above. | certify that | have reviewed the Research Plan/Project Summary and will provide direct supervision, Arenity C-_Ral os /t0/i4 Designated Supervisors Printed Name “Signature Date of Review mmiaaryy) 0905032513 Position & institution Phone or email contact information Experience/Training as relates to the student's area of research age 36 Taternational Rules: Guidelines for Science and Engineering Fairs 2018-2019, student socletyforsclence-org/intel-iseh| Student Checklist (1A) This form is required for ALL projects. 1, a. Student/Team Leader: Danise.Gin Arabella|Saniel ii Gin Arabella Sanlet Grade: 12 Email: Sanieldenise@gmail.com Phone; 99776450641 b. Team Member: Pamela Isabelle Tabirara team Member: Kristine Jane Pal 2. Title of Project: The Fixating Ability of Seaweed Extract in the Physiochemical Properties of Soil and Plant Growth ;, Davao City National High School (082)224-9889 3. School ‘School Phone: School Address: F- Torres St., Davao City 040s07-561F 4, Adult Sponsor: Azenith Pal Phone/Email: 5. Does this project need SRC/IRB/IACUC or other pre-aoproval? ClYes [1 No Tentative start date: 6. Is this a continuation/progression from a previous year? DlYes [No IfYes: a. Attach the previous year’s O Abstract and 1 Research Plan/Project Summary b. Explain how this project is new and different from previous years on CO Continuation/Research Progression Form (7) 7. This year's laboratory experiment/data collection: oe /is 4 04) av /ia ‘Actual Start Date: (mm/dd/yy) End Date: (mm/dd/yy) 8 Where will you conduct your experimentation? (check all that apply) Ci Research institution fi School OField Home 1 Other: 9. List name and address of al! non-home and non-school work site(s): Name: —Ptpaciméntnt Agdcduline Chute Labatmy) = _ Marine Mazar radu (ne Shddeanes Bang ny Sts fagclavo , Dowmo Cehy ging Gord en Lay oF Samal Phone/ email 10. Complete a Research Plan/Project Summary following the Research Plan/Project Summary instructions and attach to this form. 11. An abstract is required for all projects after experimentation. Page 30 Taternational Rules: Guidelines for Science and Engineering Fairs 2018-2019, student socletyforsclence.org/intel-isefApproval Form (1B) ‘A.completed form is required for each student, including all team members. 1. To Be Completed by Student and Parent a. Student Acknowledgment: © lunderstand the risks and possible dangers to me of the proposed research plan. + Ihave read the intel ISEF Rules and Guidelines and will adhere to all International Rules when conducting this research, + Ihave read and will abide by the following Ethics statement Student researchers are expected to maintain the highest standards of honesty erity. Scientific fraud and rnlsconduct are not condoned at any level of research or competition. Such practices include but are not limited to 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 affliated fairs and the Intel ISEF. Kristine Jane Pal Haba lofta fra Student's Printed Name Signature Date Acknowledged (mm/dd/yy) (Must be prior to experimentation) b. Parent/Guardian Approval: | have read and understand the risks and possible dangers involved in the Research Plan/Project Summary. | consent to my child participating in this research. Azenith Pal gq Iof)a Jia Parent/Guardian's Printed Name Signature L7 Date Acknowledged (mm/dd/yy) (Must be prior to experimentation) 2. To be completed by the local or affiliated Fair SRC (Required for projects requiring prior SRC/IRB APPROVAL. Sign 2a or 2b as appropriate. '& Required for projects that need prior SRC/IRB approval ’b. Required for research conducted atall Regulated Research BEFORE experimentation (humans, vertebrates or potentially Institutions with no prior fair SRC/IRB approval hazardous biological agents) oR This project was conducted ata regulated research institution “The SRC/IRB has carefully studied this project's Research Plan/ (not home or high school, etc}, was reviewed and approved Project Summary and al the required forms are included. My by the proper institutional board before experimentation and signature indicates approval ofthe Research Plan/Project compiles with the Intel [SEF Rules. Attach (1C) and any required ‘Summary before the student begins experimentation, institutional approvals (eg. IACUC, IRB). ‘SRC/IRB Chairs Printed Name Sr cae rneiian Signature Date of Approval (mmiaalyy) (Must be prior to experimentation) Signature Date of Approval (mm/dd/yy) 3. Final Intel ISEF Affiliated Fair SRC Approval (Required for ALL Projects) ‘SRC Approval After Experimentation and Before Competition at Regional/State/National Fair I certify that this project adheres to the approved Research Plan/Project Summary and complies with al Inte ISEF Rules. eaitt Sew Regional SRC Chairs Printed Name Signature Date of Approval mmyagiyyy ‘Siate)National SRC Chairs Printed Name Signature Date of Approval (mm/dd/yy) (where applicable) Page 32 Taternational Rules: Guidelines for Sclence and Engineering Fairs 2018-2019, student socletyforsclence-ora/intel-lseFApproval Form (1B) ‘A.completed form is required for each student, including all team members, 1. To Be Completed by Student and Parent a. Student Acknowledgment: + lunderstand the risks and possible dangers to me of the proposed research plan. + Ihave read the Intel ISEF Rules and Guidelines and will adhere to all International Rules when conducting this research. ‘+ Ihave read and will abide by the following Ethics statement ‘Student researchers are expected to maintain the highest standards of honesty and integrity. Scientific fraud and misconduct are not condoned at any level of research or competition. Such practices include but are not limited to plagiarism, forgery, use or presentation of other researcher's work as one’s own, and fabrication of data. Fraudulent projects will fall to qualify for competition in affiliated fairs and the Intel ISEF. Pamela Isabelle Tabirara o4-ie-l4 Student's Printed Name Signature Date Acknowledged (mm/dd/yy) (ttust be prior to experimentation) b. Parent/Guardian Approval: have read and understand the risks and possible dangers involved in the Research Plan/Project Summary. | consent to my child participating in this research. Pastor Tabirara Jr. =e 04/4 Parent/Guardian’s Printed Name Signature 7 Date Acknowledged (mm/dd/yy) (ust be prior to experimentation) 2. To be completed by the local or affiliated Fair SRC (Required for projects requiring prior SRC/IRB APPROVAL. Sign 2a or 2b as appropriate. '2 Required for projects that need prior SRC/IRB approval ’b. Required for research conducted atall Regulated Research BEFORE experimentation (humans, vertebrates or potentially Institutions with no prior fair SRC/IRB approval hazardous biological agents). oR This project was conducted at a regulated research institution ‘The SRC/IRB has carefully studied this project's Research Plan/ {not home or high school, etc), was reviewed and approved Project Summary and all the required forms are included. My by the proper institutional board before experimentation and signature indicates approval ofthe Research Plan/Project ‘complies wit the intel SEF Rules. Attach (1C) and any required Summary before the student hegins experimentation, institutional approvals (e.g. {ACUC, RB). SRC/IRB Chairs Printed Name Sec ake Pied Nae Sgraure Date of Approval (mmVaahy) (ust be prior to experimentation) Signature Date of Approval mm/dd/yy) Final Intel ISEF Affiliated Fair SRC Approval (Required for ALL Projects) ‘SRC Approval After Experimentation and Before Competition at Regional/State/National Fair | certify that this project acheres to the approved Research Plan/Project Summary anc complies with al Intel ISEF Rules. Regional SRC Chairs Printed Name Sgnare Date of Appraval mmTeayyy SiateyNational SRC Chairs Printed Name. Signature Date of Approval mm/adiyyy (where applicable) Page 32 Taternational Rules: Guidelines for Science and Engineering Fairs 2018-2019, student-socletyforsclence-org/intelise?Approval Form (1B) completed form is required for each student, including all team members. 1. To Be Completed by Student and Parent a. Student Acknowledgment: + Lunderstand the risks and possible dangers to me ofthe proposed research plan. [have read the Intel ISEF Rules and Guidelines and will adhere to all International Rules when conducting this research, + Ihave read and will abide by the following Ethics statement ‘Student researchers are expected to maintain the highest standards of honesty and integrity. Scientific fraud and misconduct are not condoned st any level of research or competition. Such practices include but are not limited to plagiarism, forgery, use or presentation of other researcher's work as one's own, and fabrication of data. Fraudulent projects will fal to qualify for competition in affiliated fairs and the Intel ISEF- Denise Gin Arabella Saniel wale Students Printed Name Signature Date Acknowledged (mm/dd/yy) (Must be prior to experimentation) b. Parent/Guardian Approval: | have read and understand the risks and possible dangers involved in the Research Plan/Project Summary. | consent to my child participating in this research. Ginalissa Saniel oa ja Parent/Guardian's Printed Name Signature Date Acknowledged (mm/dd/yy) (Must be prior to experimentation.) 2. To be completed by the local or affiliated Fair SRC (Required for projects requiring prior SRC/IRB APPROVAL. Sign 2a or 2b as appropriate) ‘a. Required for projects that need prior SRC/IRB approval 'b, Required for research conducted at all Regulated Research BEFORE experimentation (humans, vertebrates or potentially Institutions with no prior fair SRC/IRB approval. hazardous biological agers) on| This project was conducted at a regulated research institution ‘The SRC/IRB has carefully studied this project's Research Plan/ (not home or high school, etc}, was reviewed and approved Project Summary and all the required forms are included. My by the proper institutional board before experimentation and signature indicates approval ofthe Research Plan/Project complies wth the Intl ISEF Rules. Attach (1C) and any required ‘Summary before the student begins experimentation. Institutional approvals (e.g. |ACUC, IRB). ‘SRC/IRB Chairs Printed Name Sqaue—C eof Approval mma (Must be prior to experimentation) Signature Date of Approval (mm/ddlyy) 3. Final Intel ISEF Affiliated Fair SRC Approval (Required for ALL Projects) ‘SRC Approval After Experimentation and Before Competition at Regional/State/National Fair | certify that this project adheres to the approved Research Plan/Project Summary and complies with al Intel ISEF Rules Fegional SRC Chairs Pred Name Seraure Dale of Approval PHMTSRT VV) State|National SRC Chairs Printed Name Signature Date of Approval mm/adiyy) (where applicable) Page 32 Tnternational Rules: Guidelines for Science and Engineering Fairs 2018-2018, student socletyforsclence org/intel-Tser