School Registration Form for Region III MSEF

School Name*

Grades Served for Science Fair*

School Mailing Address*

Street Address Address Line 2 City ZIP Code

School Physical Address*

Street Address Address Line 2 City ZIP Code

School Telephone*

School Fax*

2023/2024 Key Teacher*

Key Teacher School Email*

Enter Email Confirm Email

Key Teacher Alternate Email*

Enter Email Confirm Email

Principal's Name*

First Last

Principal's Email*

Enter Email Confirm Email

School District

Science or Academic Curriculum Coordinator at District Office

First Last

Email of Science or Academic Curriculum Coordinator at Distrct Office

Enter Email Confirm Email

Estimate how many students will participate at your school?*

Estimate how many students you plan to send to the regional fair?*

*Please Choose Yes or No Below**

YES - Our students will be conducting experiments involving humans and/or animals. (Complete Part I and II)
NO - Our students will not be conducting experiments involving humans and/or animals. (Complete Part I only)

Please Read the Descriptions of Who May Serve

Part I: School Scienctific Review Board (SRC)

A Scientific Review Committee (SRC) is a group of adults knowledgeable about regulations concerning experimentation especially with vertebrate animals and potentially hazardous biological agents. The SRC must review and approve all projects in these areas before experimentation may begin. Shortly before competition, the Fair SRC will also review the documentation for ALL projects to ensure that students have followed all applicable rules and that the project is eligible to compete.

An SRC consists of a minimum of three members. The SRC must include at least: (a) biomedical scientist (e.g., Ph.D., M.D., D.V.M., D.D.S., D.O.); (b) science educator; (c) at least one other member. Members of the SRC may also serve on the IRB for a school. The SRC Chairperson must be a biomedical scientist who is not a classroom teacher. Refer to operations guidelines at https://sspcdn.blob.core.windows.net/files/Documents/SEP/ISEF/2016/Fair-Network/Operational-Guidelines.pdf for further information.

SRC Chairperson*

First Last

Employed by*

Employment Title*

Degree(s) and/or Qualifications*

Complete Mailing Address*

Street Address Address Line 2 City State ZIP Code

Other SRC Committee Members:

Name*

First Last

Science Educator
Other Member

Employed by*

Employment Title*

Biomedical Degree(s)*

Complete Mailing Address*

Street Address Address Line 2 City State ZIP Code

Name*

First Last

Science Educator
Other Member

Employed by*

Employment Title*

Degree(s) and/or Qualifications*

Complete Mailing Address*

Street Address Address Line 2 City State ZIP Code

Name*

First Last

Science Educator
Other Member

Employed by*

Employment Title*

Degree(s) and/or Qualifications*

Complete Mailing Address*

Street Address Address Line 2 City State ZIP Code

Name

First Last

Science Educator
Other Member

Employed by

Employment Title

Degree(s) and/or Qualifications

Complete Mailing Address

Street Address Address Line 2 City State ZIP Code

PLEASE READ THE DESCRIPTIONS OF WHO MAY SERVE

Part II: Institutional Review Board (IRB)

An Institutional Review Board (IRB) is a committee that, according to federal regulations (45-CFR-46), must evaluate the potential physical and/or psychological risk of research involving human subjects. All proposed human research must be reviewed and approved by an IRB before experimentation begins. This includes review of any surveys or questionnaires Federal regulations require local community involvement; therefore an IRB should be established at the school level to evaluate human research projects.

An IRB at the school or ISEF Affiliated Fair level must consist of a minimum of three members. In order to eliminate conflict of interest, the Adult Sponsor, parents, the Qualified Scientist, and the Designated Supervisor who oversee a specific project must not serve on the IRB reviewing that project. Additional members are recommended to help avoid this conflict of interest and to increase the expertise of the committee.

This IRB must include: (a) a science teacher; (b) a school administrator (preferably, a principal or vice principal); (c) one of the following who is knowledgeable and capable of evaluating the physical and/or psychological risk involved in a given study: a medical doctor, physician’s assistant, registered nurse, a psychiatrist, psychologist, licensed clinical counselor (professional, mental health) or licensed social worker. Refer to operations guidelines at https://sspcdn.blob.core.windows.net/files/Documents/SEP/ISEF/2016/Fair-Network/Operational-Guidelines.pdf for further information.

IRB Chairperson*

First Last

Complete Mailing Address*

Street Address Address Line 2 City State ZIP Code

Employed by*

Employment Title*

Degree(s) and/or Qualifications*

Name*

First Last

Science Teacher
Administrator
Other

Employed by*

Employment Title*

Degree(s) and/or Qualifications*

Complete Mailing Address*

Street Address Address Line 2 City State ZIP Code

Name*

First Last

Science Teacher
Administrator
Other

Employed by*

Employment Title*

Degree(s) and/or Qualifications*

Complete Mailing Address*

Street Address Address Line 2 City State ZIP Code

Name

First Last

Science Teacher
Administrator
Other

Employed by

Employment Title

Degree(s) and/or Qualifications

Complete Mailing Address

Street Address Address Line 2 City State ZIP Code

Comments

This field is for validation purposes and should be left unchanged.

Region III School Registration Form

Please Read the Descriptions of Who May Serve

Part I: School Scienctific Review Board (SRC)

Other SRC Committee Members:

PLEASE READ THE DESCRIPTIONS OF WHO MAY SERVE

Part II: Institutional Review Board (IRB)