DUE FRIDAY, JANUARY 11 , 2019 CHICAGO PUBLIC SCHOOLS STUDENT SCIENCE FAIR, INC. 2019 EXHIBITION OF STUDENT STEM RESEARCH Official Entry Form for Symposium and Essay Competition Fill in the information below. The information must be typed. Students must be in high school to participate in the Symposium Contest. Students in 7th grade, 8th grade or high school can participate in the Essay Contest. Sixth graders can participate in the Chicago Essay Contest. Age requirements for participation in the state fair are determined by the rules of the Illinois Junior Academy of Science. SYMPOSIUM ENTRY: Students must submit four (4) copies of this entry form, endorsements, abstract, media consent form and research summary to Jennifer Patush, Curie HS, GSR#37. E-mail one PDF file of all documents to [email protected] ESSAY ENTRY: Students must submit four (4) copies of the essay with the essay cover page attached to each; three (3) copies of this entry form; and a copy of the Media Consent Form. ENTRANT INFORMATION SCHOOL INFORMATION PROJECT INFORMATION Entrant Name: LAST MONTH APARTMENT NUMBER DAY FIRST Age: Address: E-mail: CPS Student I.D. Number: Name of Parent or Guardian: Gender: Phone: Birth Date: YEAR ZIP CODE CERTIFICATION: I hereby certify that the project has been personally inspected and that it fulfills all requirements as described in the handbook, including endorsements if applicable. I hereby certify that I have read all of the above information and that it is accurate. REGIONAL STEM EXHIBITION CHAIRPERSON’S SIGNATURE DATE Human SCHOOL STEM EXHIBITION COORDINATOR’S SIGNATURE DATE LAST FIRST Microbiology Human/Vertebrate Animal Tissue No Endorsement Needed Vertebrate Animal Recombinant DNA Check Type of Endorsement(s) Attached Category Number: Category Name Teacher/ Sponsor Name LAST FIRST School STEM Exhibition Coordinator (if different from teacher/sponsor) Teacher/ Sponsor E-mail School STEM Exhibition Coordinator E-mail Title: School STEM Exhibition Coordinator Phone: Cannot exceed 45 spaces including spaces between words Organism(s) Used in Experiment: INSERT THE CORRESPONDING SET OF NUMERALS AND CATEGORY NAME IN THE BOXES PROVIDED. 10 Environmental Science 11 Health Science 12 Materials Science 13 Mathematics 14 Microbiology 15 Physics 16 Zoology 17 Essay Competition 01 Aero-Space Science 02 Behavioral Science 03 Biochemistry 04 Botany 05 Chemistry 06 Computer Science 07 Earth Science 08 Electronics 09 Engineering Science SPACES BETWEEN WORDS ARE TO BE INCLUDED IN THE TOTAL OF 45. *A COPY OF THE ENDORSEMENT(S), ABSTRACT, AND CPS IMAGE CONSENT FORM MUST BE ATTACHED TO THIS ENTRY FORM. Phone: Fax EXPERIMENTAL PROJECT Check One: DESIGN PROJECT GRADE School ID# NETWORK SCHOOL GSR# Firearms Endorsement
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DUE FRIDAY, JANUARY 11, 2019
CHICAGO PUBLIC SCHOOLS STUDENT SCIENCE FAIR, INC.
2019 EXHIBITION OF STUDENT STEM RESEARCHOfficial Entry Form for Symposium and Essay Competition
Fill in the information below. The information must be typed. Students must be in high school to participate in the Symposium Contest. Students in 7th grade, 8th grade or high school can participate in the Essay Contest. Sixth graders can participate in the Chicago Essay Contest. Age requirements for participation in the state fair are determined by the rules of the Illinois Junior Academy of Science.
SYMPOSIUM ENTRY: Students must submit four (4) copies of this entry form, endorsements, abstract, media consent form and research summary to Jennifer Patush, Curie HS, GSR#37. E-mail one PDF �le of all documents to [email protected]
ESSAY ENTRY: Students must submit four (4) copies of the essay with the essay cover page attached to each; three (3) copies of this entry form; and a copy of the Media Consent Form.
ENTR ANT INFORMATION
SCHOOL INFORMATION
PROJECT INFORMATION
Entrant Name:LAST
MONTH
APAR TMENT NUMBER
DAY
FIRST
Age:
Address:
E-mail:
CPS Student I.D. Number:Name of
Parent or Guardian:
Gender: Phone: Birth Date:YEAR
ZIP CODE
CERTIFICATION:I hereby certify that the project has been personally inspected and that it ful�lls all requirements as described in the handbook, including endorsements if applicable.
I hereby certify that I have read all of the above information and that it is accurate.
REGIONAL STEM EXHIBITION CHAIRPERSON’S SIGNATURE DATE
Human
SCHOOL STEM EXHIBITION COORDINATOR’S SIGNATURE DATE
LAST FIRST
Microbiology
Human/VertebrateAnimal Tissue
No EndorsementNeeded
Vertebrate Animal
Recombinant DNACheck Type ofEndorsement(s) Attached
CategoryNumber:
CategoryName
Teacher/Sponsor Name
LAST FIRST
School STEM ExhibitionCoordinator
(if different from teacher/sponsor)
Teacher/Sponsor E-mail
School STEM Exhibition Coordinator E-mail
Title:
School STEM Exhibition Coordinator Phone:
Cannot exceed 45 spaces including spaces between words
Organism(s) Used in Experiment:INSERT THE CORRESPONDING SET OF NUMERALS AND CATEGORY NAME IN THE BOXES PROVIDED.
10 Environmental Science11 Health Science12 Materials Science
13 Mathematics14 Microbiology15 Physics
16 Zoology17 Essay Competition
01 Aero-Space Science02 Behavioral Science03 Biochemistry
04 Botany05 Chemistry06 Computer Science
07 Earth Science08 Electronics09 Engineering Science
SPACES BETWEEN WORDS ARE TO BE INCLUDED IN THE TOTAL OF 45.
*A COPY OF THE ENDORSEMENT(S), ABSTRACT, AND CPS IMAGE CONSENT FORM MUST BE ATTACHED TO THIS ENTRY FORM.
Phone: Fax
EXPERIMENTALPROJECT
Check One:DESIGNPROJECT
GRADE School ID# NE T WORK SCHOOL GSR#
Firearms Endorsement
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