Qualifi ed Scientist Form (2)
May be required for research involving human participants, vertebrate animals, potentially hazardous biological agents, and
DEA-controlled substances. Must be completed and signed before the start of student experimentation.
Student’s Name(s)
Title of Project
To be completed by the Qualifi ed Scientist:
Scientist Name:
Educational Background:
Degree(s):
Experience/Training as relates to the student’s area of research:
Position:
Institution:
Address:
Email/Phone:
1) Have you reviewed the Intel ISEF rules relevant to this project?
Yes
No
2. Will any of the following be used?
a. Human participants
Yes
No
b. Vertebrate animals
Yes
No
c. Potentially hazardous biological agents (microorganisms, rDNA and tissues,
including blood and blood products)
Yes
No
d. DEA-controlled substances
Yes
No
3. Was this study a sub-set of a larger study?
Yes
No
4. Will you directly supervise the student?
Yes
No
a.
If no, who will directly supervise and serve as the Designated Supervisor?
To be completed by the Designated Supervisor
To be completed by the Qualifi ed Scientist:
when the Qualifi ed Scientist cannot directly supervise.
I certify that I have reviewed and approved the Research
Plan prior to the start of the experimentation. If the student
I certify that I have reviewed the Research Plan and have been
or Designated Supervisor is not trained in the necessary
trained in the techniques to be used by this student, and I will
procedures, I will ensure her/his training. I will provide advice and
provide direct supervision.
supervision during the research. I have a working knowledge of
the techniques to be used by the student in the Research Plan.
I understand that a Designated Supervisor is required when
Designated Supervisor’s Printed Name
the student is not conducting experimentation under my direct
supervision.
Signature
Date of Approval
Qualifi ed Scientist’s Printed Name
Signature
Date of Approval
Phone
Email
International Rules: Guidelines for Science and Engineering Fairs 2014–2015,
Page 33
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