| EISEF student signature page for Student_1_firstname Student_1_lastname | Date_Time_Stamp |
- Use your web browser to print all the sheets of this page. Optionally use your web browser to save the page as a file, for future reference or in case of printer problems.
- All the student experimenters and the adult sponsor must sign the printed page.
- Mail or email all the sheets of the signed page to the EISEF address at the bottom of the page. Include copies (not the originals!) of all the other forms and certificates your project requires. Mail the whole package by February 26, 2024, nineteen days before the Fair.
- Until we receive your signed paperwork, we will not fully accept your entry, and we won’t let you check in on Fair Day.
- Bring your originals with you to the Fair on March 16.
| Student Certification | ||||
| I am the student responsible for the exhibit described below. Excluding information assistance, this exhibit is the result of my efforts. This exhibit is not an identical repetition of an exhibit shown in previous years. I have read the rules of the Eastern Iowa Science & Engineering Fair combined with those of the International Science and Engineering Fair and, to the best of my knowledge, I have complied with those rules. | ||||
| I have read and understood the EISEF Privacy Policy (http://www.eisef.org/pmwiki/index.php/Web/PrivacyPolicy). I understand that the Eastern Iowa Science and Engineering Fair is a public event, and I give EISEF and others permission to publish my personal information (name, exhibit title, school, teacher, and picture) in various fair-related promotional materials, including press releases, the EISEF website, and other websites. | ||||
| (signed) Student_1_firstname Student_1_lastname | (date) | (signed) Student_2_firstname Student_2_lastname | (date) | |
| (signed) Student_3_firstname Student_3_lastname | (date) | |||
| Adult Sponsor Certification | ||||
|
I am the adult responsible for the exhibit described below. To the best of my knowledge this exhibit is not an identical repetition of an exhibit shown in previous years. I have read the rules of the Eastern Iowa Science & Engineering Fair combined with the those of the International Science and Engineering Fair and to the best of my knowledge, the student has complied with those rules. | ||||
| (signed) Sponsor_name | (date) | |||
| Rules Certification (This is in lieu of ISEF certificates, for Junior exhibits only) | ||||
| I have read the rules of the Eastern Iowa Science and Engineering Fair. I have examined the experiment and the exhibit and they comply with safety procedures and display requirements of the rules. Any vertebrate animals associated with this experiment were handled in manners prescribed in the rules. Any training or supervision needed by the student or adult sponsor was acquired in a timely manner. Any human subjects were treated in a manner that did not place them at undue risk. All interview material has been handled in a manner that protects the confidentiality of the persons involved. All human subjects were informed of the purpose of the experiment and the risks involved, if those risks were evident. Any tissue required for this experiment was acquired in a manner consistent with the rules. | ||||
| (signed) Sponsor_name | (date) | (signed) Student_1_firstname Student_1_lastname | (date) | |
| (signed) Student_2_firstname Student_2_lastname | (date) | (signed) Student_3_firstname Student_3_lastname | (date) | |
| Submit all entries no later than , approximately three weeks prior to the EISEF. If a student must cancel, please help us out by phoning or e-mailing as soon as possible. Mail or e-mail this signed form (and a copy of each certificate) to one of these addresses: | |
| EISEF Safety & Standards Committee PO Box 10862 Cedar Rapids, IA 52410–0862 | E-mail as PDF attachments to: |
| Exhibit information | |
|---|---|
| Number of students | Project_size |
| Age group | Age_group |
| Research category | Research_category |
| Exhibit title | Exhibit_title |
| Exhibit description | Exhibit_description |
| Exhibit sits on? | Table_vs_floor |
| Electricity needed? | Electricity_needed |
| Special needs | Special_needs |
| Student #1 information | |
|---|---|
| Name | Student_1_firstname Student_1_lastname |
| Grade in school | Student_1_grade |
| E-mail address | Student_1_email |
| Parent or guardian | Student_1_parent |
| Mailing address | Student_1_address Student_1_city, Student_1_state Student_1_zipcode |
| Home phone | Student_1_home_phone |
| Adult sponsor information | |
|---|---|
| Name | Sponsor_name |
| School | Student_school_name, Student_school_city |
| Mailing address | Sponsor_address_1 Sponsor_address_2 Sponsor_city, Sponsor_state Sponsor_zipcode |
| Daytime phone | Sponsor_daytime_phone |
| Evening phone | Sponsor_evening_phone |
| E-mail addresses | Sponsor_email_primary Sponsor_email_secondary |
| Team member #3 information | |
|---|---|
| Name | Student_3_firstname Student_3_lastname |
| Grade in school | Student_3_grade |
| E-mail address | Student_3_email |
| Parent or guardian | Student_3_parent |
| Mailing address | Student_3_address Student_3_city, Student_3_state Student_3_zipcode |
| Home phone | Student_3_home_phone |
| Team member #2 information | |
|---|---|
| Name | Student_2_firstname Student_2_lastname |
| Grade in school | Student_2_grade |
| E-mail address | Student_2_email |
| Parent or guardian | Student_2_parent |
| Mailing address | Student_2_address Student_2_city, Student_2_state Student_2_zipcode |
| Home phone | Student_2_home_phone |