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OFFICIAL ABSTRACT and CERTIFICATION


Category
Agas-moro (Vernonia cinerea Linn.) Anti-CF (Cold and Fever) Ointment Pick one only
Yveth V. Gameng, Jenylyn V. Cortado, Giselle Anne G. Valdez mark an X in
box at right
Candon National High School, Candon City, Philippines
Animal Sciences
This study entitled "Agas-moro (Vernonia cinerea Linn.) Anti-CF (Cold and Fever) Ointment" aims Behavioral and
to give treatment to the most catched diseases nowadays, the cold, cough, and fever. This study can Social Science

help some mothers because instead of buying expensive medicine or treatment for their children having Biochemistry
the CCF, they can just look for agas-moro around their surroundings. Cellular &
Molecular Biology
This study entitled "Agas-moro (Vernonia cinerea Linn.) Anti-CF (Cold and Fever) Ointment"
Chemistry
was investigated to prove the hypotheses that aga-moro can be utilized and effective reliever
Computer Science
ointment.
Earth Science
Specifically, these hypotheses were formulated.
Eng: Electrical &
1. Agas-moro is an effective ointment for cold and fever. Mechanical
2. There is no significant difference between the agas-moro (Vernonia cinerea Linn.)
Eng: Materials &
ointment and the commercialized ointment (VAPOCOOL). Bioengineering
The researchers gathered and washed fifty grams (50 g) of agas-moro and soaked to one Energy &
hundred milliliters (100 ml) of ethyl alcohol for twenty four hours (24 hrs). After soaking, the researchers Transportation

melted the one hundred twenty five grams (125g) of beeswax and mixed with the extract of agas-moro. Environmental
Management
The researchers mixed also the extracted ten grams (10g) of eucalyptus leaves and transferred to a
Environmental
clean container. Sciences
Based on the findings, the agas-moro can be utilized as an ointment to relieve colds and fever Mathematical
Further study is recommended to improve the expiration and packaging of the product. Sciences
Medicine and
Health
Microbiology
As a part of this research project, the student directly handled, manipulated, or Plant Sciences
interacted with (check ALL that apply): Physics and
Astronomy
human subjects potentially hazardous biological agents
vertebrate animals Microorganisms rDNA tissue
2. This abstract describes only procedures performed by me/us,
reflects my/our own independent research, and represents one Yes No
years work only

3. I/we worked or used equipment in a regulated research Yes No


institution or industrial setting:

4. This project is a continuation of previous research. Yes No

5. My display board includes non-published photographs/visual Yes No


depictions of humans (other than myself):

6. I/we hereby certify that the abstract and responses to the Yes No
above statements are correct and properly reflect my/our own work.

This stamp or embossed seal attests that this project is in compliance with all federal
and state laws and regulations and that all appropriate reviews and approvals have
been obtained including the final clearance by the Scientific Review Commit
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TABLE OF CONTENTS
TITLE PAGE..1

ABSTRACT.2

TABLE OF COBTENTS....3

ACKNOWLEDGEMENT.4

CHAPTER I..5
RESEARCH PLAN...5
A. Question or Problem ..5
B. Goals/Unexpected Outcomes/Hypotheses.5
C. Methods and Procedure.5-6
D. Bibliography6

CHAPTER II..7
RESEARCH DATA BOOK..7

CHAPTER III.8
RESEARCH PAPER.8
A. TITLE PAGE .8
B. INTRODUCTION..8
a. Background of the Study.8
b. Statement of the Problem....8
c. Formulation of Hypotheses10
d. Significance of the Study10
e. Scope and Limitation..11
f. Theoretical Framework..11
g. Conceptual Framework..12
C. METHODS AND MATERIALS..13
D. RESULTS AND DISCUSSION13-14
E. CONCLUSIONS AND RECOMMENDATIONS...15
F. BIBLIOGRAPHY.15

FORMS...16-36
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ACKNOWLEDGEMENT

In appreciation to the full support in the completion of this investigatory project entitled: Tamarind (Tamarindus

indica) Seeds Coffee. The researchers hereby acknowledged the personnel for their unselfish guidance and

direction;

To Mr. Danilo Basabas, the Supervisor of the Science Department for giving words of wisdoms and

sharing knowledge about the project; to Mrs. Pacita L. Basabas, the school Principal for permitting the

researchers to use the facilities of the school in connection to the study and had given sincere inspiration towards

the work; to Ms. Cecilia Galinta, the Head Teacher of the Science Department for checking and who suggested

some important parts of this study; to Ms. Ann Marie J. Baltazar for guising us in writing the write up and the

whole written work and to the researchers families and friends for lending some materials, for shouldering the

financial aspects and sharing ideas about the project.

Above all, the researchers expressed their thanks to God Almighty for giving the courage to complete

this investigatory project.

The researchers,

Charity Ribucan
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CHAPTER II
PROJECT DATA BOOK
Week
Activities 1 2 3 4 5 6

Planning the investigatory project /

Setting the Experiment /

Listing of materials needed /

Writing the rough draft procedure /

Experimentation /

Finalizing the experiment /

Gathering of Result /

Data Presentation /

Data analysis /

Finalizing the project /

The researchers started planning their investigatory project which entitled, Tamarind (Tamarindus Indica) on the
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Republic of the Philippines

Region I
Candon City Division
CANDON NATIONAL HIGH SCHOOL

Tamarind
(Tamarindus
Indica)
RESEARCHERS
Yveth V. Gameng
Jenylyn V. Cortado
Giselle Anne G. Valdez
IV- Michael Faraday
Candon National High School

CHAPTER III
RESEARCH PAPER
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INTRODUCTION

A. BACKGROUND OF THE STUDY

B. STATEMENT OF THE PROBLEM

This investigatory project entitled "Tamarind (Tamarindus Indica)" aimed to produce an

effective yet affordable coffee. Specifically, it sought to answer the following questions:

1. How effective the Tamarind (Tamarindus Indica) is?

2. Is there a significant difference between Tamarind (Tamarindus Indica) as compared to the commercial

one?

C. FORMULATION OF HYPOTHESES

To arrive with the answer of this research, the following hypotheses are formulated:

1. Tamarind (Tamarindus Indica) is an effective coffee.


2. There is a significant difference between the tamarind (Tamarindus Indica) as compare to the
commercialized one (nescafe)

D. SIGNIFICANCE OF THE STUDY

The use of the eco-friendly tamarind is considered alternative due to its effectiveness, low cost and

availability of resources. The results of the study are of great help to the following:

STUDENTS, CITIZENS, AND OTHER PEOPLE IN THE COUNTRY

They can now use a cheaper coffee and dont have to spend too much money for those expensive

beverages.
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ENVIRONMENTALISTS

Since, the Tamarind (Tamarindus Indica) is made from organic matter, it is more eco-friendly

compared to the commercialized coffee which are made of (mostly combinations of pure elements). Thus,

it helps a lot in promoting the advocacies of such environmental groups.

RESEARCHERS

Those who will conduct the same study, or related study on this, they may use the findings as their

bases for a better research.

E. This study was focused on the determination of the effectiveness of Tamarind (Tamarindus Indica) as

coffee as compared to commercial coffee found in the market. This was conducted at the researchers

addresses at Balingaoan, Candon City, Ilocos Sur and it is also conducted at Candon National High

School, Bagani Campo, Candon City, Ilocos Sur.

This study has the following limitations: First, the study was tried only by the researchers and their

families. Second, the study was tried for two trials and any observation for the effectiveness.

F. THEORETICAL FRAMEWORK

GATHERING MATERIALS

PREPAIRING MATERIALS

EXTRACTING

HEATING

MIXING
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COOLING

G. CONCEPTUAL FRAMEWORK

The

were gathered

The were washed


and prepared

The

The

The

The
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MATERIALS AND METHODS


The researchers used the following materials in the production of the product.

On the production of the product, the researchers gathered and washed

RESULTS & DISCUSSION


After executing all the procedures to produce an effective coffee from the seeds of Tamarind

(Tamarindus Indica) and after testing the product, the researcher came up with the results showed below.

Table 1.

This was sufficient for executing the experiment in the variables, testing and observing as well.

Table 2. Effectiveness of the Tamarind

Trials Effectiveness
1 Accepted

2 Accepted

LEGEND:

Highly Accepted- its effectiveness is very good.

Effective its effectiveness good enough

Not Effective its not good


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The table shows that Tamarind (Tamarindus indica) is an effective coffee. It also shows in the table that
Tamarind (Tamarindus Indica) is accepted in terms of the effectiveness of it.

Table 3. The number of trial and corresponding results.

No. of trials Days Coffee Results

Tamarind Coffee Tamarind Coffee is


1 1
Commercial Coffee effective

Tamarind Coffee Tamarind Coffee is


2 2
Commercial Coffee effective

Table 3 presented the results of the study. It showed the number of trials with the corresponding days and
the results of the study. Results showed that after 1 day of using it, this was effective, similar with the commercial
one. This means that Tamarind is effective.

CONCLUSION AND RECOMMENDATIONS


Results of the study showed that the Tamarind (Tamarindus Indica) can be a source of making

coffee and it is effective. This could not only make us save but also can lessen pollution in the

environment. There is a significant difference between the Tamarind (Tamarindus Indica) and the

commercial ones.
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For further study, the researchers recommend to improve the quality of the Tamarind (Tamarindus

Indica), especially on its odor and appearance. The researchers recommend using this product in

order for us to lessen the waste in our environment.

BIBLIOGRAPHY
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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):


Students Name(s):

Project Title: Tamarind( Tamarindus Indica) Seeds Coffee


1) I have reviewed the Intel ISEF Rules and Guidelines.
2) I have reviewed the students completed Student Checklist (1A) and Research Plan.
3) I have worked with the student and we have discussed the possible risks involved in the project.
4) 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 MicroorganismsrDNATissues

5) Items to be completed for ALL PROJECTS


Adult Sponsor Checklist (1) Research Plan
Student Checklist (1A) Approval Form (1B)
Regulated Research Institutional/Industrial Setting Form (1C) (when applicable after completed experiment)
Continuation/Research Progression Form (7) (when applicable)
6) Additional forms required if the project includes the use of one or more of the following (check all that apply):
Humans(Requires prior approval by an Institutional Review Board (IRB); see full text of the rules.)
Human Participants Form (4) or appropriate Institutional IRB documentation
Sample of Informed Consent Form (when applicable and/or required by the IRB)
Qualified Scientist Form (2) (when applicable and/or required by the IRB)
Vertebrate Animals(Requires prior approval, see full text of the rules.)
Vertebrate Animal Form (5A)for projects conducted in a school/home/field research site (SRC prior
approval required.)
Vertebrate Animal Form (5B)for projects conducted at a Regulated Research Institution. (Institutional
Animal Care and Use Committee (IACUC) approval required prior experimentation.)
Qualified Scientist Form (2) (Required for all vertebrate animal projects at a regulated research site or
when applicable)
Potentially Hazardous Biological Agents (Requires prior approval by SRC, IACUC or Institutional Biosafety
Committee (IBC), see full text of the rules.)
Potentially Hazardous Biological Agents Risk Assessment Form (6A)
Human and Vertebrate Animal Tissue Form (6B)to be completed in addition to Form 6A when projectinvolves
the use of fresh or frozen tissue, primary cell cultures, blood, blood products and body fluids.
Qualified Scientist Form (2) (when applicable)
Risk Assessment Form (3) required for projects involving protists, archae and similar microorganisms,
forprojects using manure for composting, fuel production or other non-culturing experiments, for projects
using color change coliform water test kits, microbial fuel cells, and for projects involving decomposing
vertebrate organisms
Hazardous Chemicals, Activities and Devices (No prior approval required, see full text of the rules.)
Risk Assessment Form (3)
Qualified Scientist Form (2) (required for projects involving DEA-controlled substances or
whenapplicable)

ANN MARIE J. BALTAZAR


Adult Sponsors Printed Name Signature Date of Review

Phone: ___________ Email: annmarie_baltazar@yahoo.com


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Student Checklist (1A)


This form is required for ALL projects

1) a. Student/Team Leader: Grade:

Email: Phone:
b. Team Member: c. Team Member:
Tamarind (Tamarindus
2) Title of Project: Indica) Seeds Coffee

3) School: CNHS School Phone: 742-6456

School Address: Bagani Campo, Candon City


Ilocos Sur

4) Adult Sponsor: Ann Marie J. Baltazar Phone/Email: annmarie_baltazar@yahoo.com

5) Is this a continuation/progression from a previous year? Yes No


If Yes:
a) Attach the previous years Abstract and Research Plan
b) Explain how this project is new and different from previous years on Continuation/Research
Progression Form (7)

6) This years laboratory experiment/data collection: (must be stated (mm/dd/yy))

Start Date: (mm/dd/yy) End Date: (mm/dd/yy)

7) Where will you conduct your experimentation? (check all that apply)
Research Institution School Field Home Other: ________________________

8) List name and address of all non-school work site(s):

Name:
Address:

Phone:

9) Complete a Research Plan following the Research Plan instructions and attach to this form.
10) An abstract is required for all projects after experimentation.
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Research Plan Instructions


A complete research plan is required and must accompany Checklist for Student (1A)

Provide a typed research plan and attach to Student Checklist (1A). Please include your name on each page.
The research plan for ALL projects is to include the following:
A. Question or Problem being addressed
B. Goals/Expected Outcomes/Hypotheses
C. Description in detail of method or procedures (The following are important and key items that should be included
when formulating ANY AND ALL research plans.)
Procedures: Detail all procedures and experimental design to be used for data collection
Risk and Safety: Identify any potential risks and safety precautions to be taken.
Data Analysis: Describe the procedures you will use to analyze the data/results that answer research questions or
hypotheses
D. Bibliography: List at least five (5) major references (e.g. science journal articles, books, internet sites) from your
literature review. If you plan to use vertebrate animals, one of these references must be an animal care reference. o
Choose one style and use it consistently to reference the literature used in the research plan
o Guidelines can be found in the Student Handbook
Items 14 below are subject-specific guidelines for additional items to be included in your research plan as applicable:
1. Human participants research:
Participants. Describe who will participate in your study (age range, gender, racial/ethnic composition). Identify any
vulnerable populations (minors, pregnant women, prisoners, mentally disabled or economically disadvantaged).
Recruitment. Where will you find your participants? How will they be invited to participate?
Methods. What will participants be asked to do? Will you use any surveys, questionnaires or tests? What is the
frequency and length of time involved for each subject?
Risk Assessment
o Risks. What are the risks or potential discomforts (physical, psychological, time involved, social, legal, etc.) to
participants? How will you minimize the risks?
o Benefits. List any benefits to society or each participant.
Protection of Privacy. Will any identifiable information (e.g., names, telephone numbers, birth dates, email addresses) be
collected? Will data be confidential or anonymous? If anonymous, describe how the data will be collected anonymously. If
not anonymous, what procedures are in place for safeguarding confidentiality? Where will the data be stored? Who will
have access to the data? What will you do with the data at the end of the study?
Informed Consent Process. Describe how you will inform participants about the purpose of the study, what they will be
asked to do, that their participation is voluntary and they have the right to stop at any time.
2. Vertebrate animal research:
Briefly discuss potential ALTERNATIVES to vertebrate animal use and present a detailed justification for use of
vertebrate animals
Explain potential impact or contribution this research may have
Detail all procedures to be used
o Include methods used to minimize potential discomfort, distress, pain and injury to the animals during the
course of experimentation
o Detailed chemical concentrations and drug dosages
Detail animal numbers, species, strain, sex, age, source, etc.
o Include justification of the numbers planned for the research
Describe housing and oversight of daily care
Discuss disposition of the animals at the termination of the study
3. Potentially Hazardous Biological Agents:
Describe Biosafety Level Assessment process and resultant BSL determination
Give source of agent, source of specific cell line, etc.
Detail safety precautions
Discuss methods of disposal
4. Hazardous Chemicals, Activities & Devices:
Describe Risk Assessment process and results
Detail chemical concentrations and drug dosages
Describe safety precautions and procedures to minimize risk
Discuss methods of disposal
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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:
I understand the risks and possible dangers to me of the proposed research plan.
I have read the Intel ISEF Rules and Guidelines and will adhere to all International Rules when
conducting this research.
I have read and will abide by the following Ethics statement
Scientific fraud and misconduct are not condoned at any level of research or competition. Such practices include
plagiarism, forgery, use or presentation of other researchers work as ones own, and fabrication of data.
Fraudulent projects will fail to qualify for competition in affiliated fairs and the Intel ISEF.

Students Printed Name Signature Date Acknowledged (mm/dd/yy)


(Must be prior to experimentation.)
b) Parent/Guardian Approval: I have read and understand the risks and possible dangers involved in the
Research Plan. I consent to my child participating in this research.

Parent/Guardians 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 b) Required for research conducted at all Regulated
approval BEFORE experimentation Research Institutions with no prior fair SRC/IRB
(humans, vertebrates or potentially hazardous approval.
biological agents) OR This project was conducted at a regulated research
institution (not home or high school, etc.), was
The SRC/IRB has carefully studied this projects Research reviewed and approved by the proper institutional
Plan and all the required forms are included. My signature board before experimentation and complies with the
indicates approval of the Research Plan before the Intel ISEF Rules. Attach (1C) and required institutional
student begins experimentation. approvals (e.g. IACUC, IRB).

SRC/IRB Chairs Printed Name SRC Chairs Printed Name

Signature Date of Approval (mm/dd/yy)


Signature Date of Approval (mm/dd/yy)
(Must be prior to experimentation.)

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 and complies with all Intel ISEF Rules.

Regional SRC Chairs Printed Name Signature Date of Approval

State/National SRC Chairs Printed Name Signature Date of Approval


(where applicable)
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Approval Form (1B)


A completed form is required for each student, including all team members.

2) To Be Completed by Student and Parent


a) Student Acknowledgment:
I understand the risks and possible dangers to me of the proposed research plan.
I have read the Intel ISEF Rules and Guidelines and will adhere to all International Rules when
conducting this research.
I have read and will abide by the following Ethics statement
Scientific fraud and misconduct are not condoned at any level of research or competition. Such practices include
plagiarism, forgery, use or presentation of other researchers work as ones own, and fabrication of data.
Fraudulent projects will fail to qualify for competition in affiliated fairs and the Intel ISEF.

Students Printed Name Signature Date Acknowledged (mm/dd/yy)


(Must be prior to experimentation.)
c) Parent/Guardian Approval: I have read and understand the risks and possible dangers involved in the
Research Plan. I consent to my child participating in this research.

Parent/Guardians 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 b) Required for research conducted at all Regulated
approval BEFORE experimentation Research Institutions with no prior fair SRC/IRB
(humans, vertebrates or potentially hazardous approval.
biological agents) OR This project was conducted at a regulated research
institution (not home or high school, etc.), was
The SRC/IRB has carefully studied this projects Research reviewed and approved by the proper institutional
Plan and all the required forms are included. My signature board before experimentation and complies with the
indicates approval of the Research Plan before the Intel ISEF Rules. Attach (1C) and required institutional
student begins experimentation. approvals (e.g. IACUC, IRB).

SRC/IRB Chairs Printed Name SRC Chairs Printed Name

Signature Date of Approval (mm/dd/yy)


Signature Date of Approval (mm/dd/yy)
(Must be prior to experimentation.)

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 and complies with all Intel ISEF Rules.

Regional SRC Chairs Printed Name Signature Date of Approval

State/National SRC Chairs Printed Name Signature Date of Approval


(where applicable)
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Approval Form (1B)


A completed form is required for each student, including all team members.

3) To Be Completed by Student and Parent


a) Student Acknowledgment:
I understand the risks and possible dangers to me of the proposed research plan.
I have read the Intel ISEF Rules and Guidelines and will adhere to all International Rules when
conducting this research.
I have read and will abide by the following Ethics statement
Scientific fraud and misconduct are not condoned at any level of research or competition. Such practices include
plagiarism, forgery, use or presentation of other researchers work as ones own, and fabrication of data.
Fraudulent projects will fail to qualify for competition in affiliated fairs and the Intel ISEF.

Students Printed Name Signature Date Acknowledged (mm/dd/yy)


(Must be prior to experimentation.)
d) Parent/Guardian Approval: I have read and understand the risks and possible dangers involved in the
Research Plan. I consent to my child participating in this research.

Parent/Guardians 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 b) Required for research conducted at all Regulated
approval BEFORE experimentation Research Institutions with no prior fair SRC/IRB
(humans, vertebrates or potentially hazardous approval.
biological agents) OR This project was conducted at a regulated research
institution (not home or high school, etc.), was
The SRC/IRB has carefully studied this projects Research reviewed and approved by the proper institutional
Plan and all the required forms are included. My signature board before experimentation and complies with the
indicates approval of the Research Plan before the Intel ISEF Rules. Attach (1C) and required institutional
student begins experimentation. approvals (e.g. IACUC, IRB).

SRC/IRB Chairs Printed Name SRC Chairs Printed Name

Signature Date of Approval (mm/dd/yy)


Signature Date of Approval (mm/dd/yy)
(Must be prior to experimentation.)

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 and complies with all Intel ISEF Rules.

Regional SRC Chairs Printed Name Signature Date of Approval

State/National SRC Chairs Printed Name Signature Date of Approval


(where applicable)
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Regulated Research Institutional/Industrial Setting Form (1C)


This form must be completed AFTER experimentation by the adult supervising the student research conducted
in a regulated research institution, industrial setting or any work site other than home, school or field.
This form MUST be displayed with your project; responses must be on the form.

Students Name(s)

Title of Project Tamarind (Tamarindus Indica) Seeds Coffee

To be completed by the Supervising Adult in the Setting (NOT the Student(s)) after experimentation:
(Responses must remain on the form as it is required to be displayed at students project booth.)

The student(s) conducted research at my work site:


a) to use the equipment b) to perform experiment(s)/conduct research

1) Is this research a subset of your work? Yes No

2) Have you reviewed the Intel ISEF rules relevant to this project? Yes No

3) How did the student get the idea for her/his project?
(e.g. Was the project assigned, picked from a list, an original student idea, etc.)

4) Did the student(s) work on the project as a part of a research group? YesNo
If yes, how large was the group and what kind of research group was it (students, group of adult researchers, etc.)

5) What specific procedures or equipment did the student(s) actually use for the project?
Please list and describe. (Do not list procedures student only observed.)

6) How independent or creative was the students/students work?

Student research projects dealing with human participants, vertebrate animals or potentially hazardous
biological agents require review and approval by an institutional regulatory board (IRB/IACUC/IBC). Copy of
approval(s) must be attached, if applicable.
ANN MARIE J. BALTAZAR
Supervising Adults Printed Name Signature Title

Candon National High School


Institution Date Signed (must be after experimentation)

San Esteban annmarie_baltazar@yahoocom


Address Email/Phone
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Risk Assessment Form (3)


Required for projects using hazardous chemicals, activities or devices and microorganisms
exempt from pre-approval. Must be completed before experimentation.

Students Name(s)

Title of Project: Tamarind (Tamarindus Indica) Seeds Coffee

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. List/identify microorganisms exempt from pre-approval (see Potentially Hazardous Biological Agent
rules), and all hazardous chemicals, activities, or devices that will be used.

2. Identify and assess the risks involved in this project.

3. Describe the safety precautions and procedures that will be used to reduce the risks.

4. Describe the disposal procedures that will be used (when applicable).

5. List the source(s) of safety information.

To be completed and signed by the Designated Supervisor (or Qualified Scientist, when applicable):
I agree with the risk assessment and safety precautions and procedures described above. I certify that I have
reviewed the Research Plan and will provide direct supervision.

Designated Supervisors Printed Name Signature Date of Review (mm/dd/yy)

Position & Institution Phone or email contact information

Experience/Training as relates to the students area of research


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Human Participants Form (4)


Required for all research involving human participants not at a Regulated Research Institution. If at a Regulated Research Institution,
use institutional approval forms for documentation of prior review and approval.
(IRB approval required before experimentation.)

Irish Joy R. Delos Santos, Erika Mae de Guia, LennieMay Galope Narra Sawdust as an Alternative Varnish

Students Name(s) Title of Project


Benilda Galope

Adult Sponsor Contact Phone/Email


Must be completed by Student Researcher(s) in collaboration with the Adult Sponsor/Designated Supervisor/Qualified
Scientist:
1. I have submitted my Research Plan which addresses ALL areas indicated in the Human Participants Section of
theResearch Plan Instructions.
2. I have attached any surveys or questionnaires I will be using in my project.
Any published instrument(s) used was /were legally obtained.

3. I have attached an informed consent that I would use if required by the IRB.
4. Yes No Are you working with a Qualified Scientist? If yes, attach the Qualified Scientist Form 2

Must be completed by Institutional Review Board (IRB) after review of the research plan. The submitted Research Plan
must address all areas indicated on the Human Participants section of the Research Plan Instructions.
Check one of the following:
Research project requires revisions and is NOT approved at this time. IRB will attach document indicating
concerns and/or requested revisions.
Research project is Approved with the following conditions below: (All 5 must be answered)
1. Risk Level (check one) : Minimal Risk More than Minimal Risk
2. Qualified Scientist (QS) Required: Yes No
3. Written Minor Assent required for minor participants:
YesNoNot applicable (No minors in this study)
4. Written Parental Permission required for minor participants:
YesNoNot applicable (No minors in this study)
5. Written Informed Consent required for participants 18 years or older:
YesNoNot applicable (No participants 18 yrs or older in this study)

IRB SIGNATURES (All 3 signatures required) None of these individuals may be the adult sponsor, designated supervisor,
qualified scientist or related to (e.g., mother, father of) the student (conflict of interest).
I attest that I have reviewed the students project and agree with the above IRB determinations.

Medical or Mental Health Professional (a psychologist, medical doctor, licensed social worker, licensed clinical professional
counselor, physicians assistant, or registered nurse)

Printed Name Degree/Professional License

Signature Date of Approval (Must be prior to experimenta tion.)

Educator
MS. BENILDA GALOPE
Printed Name Degree

Signature Date of Approval (Must be prior to experimenta tion.)

School Administrator
MR. MARINO GALIMBA
Printed Name Degree
Signature:
P a g e | 23

Human Informed Consent Form


Instructions to the Student Researcher(s): An informed consent/assent/permission form should be
developed in consultation with the Adult Sponsor, Designated Supervisor or Qualified Scientist.
This form is used to provide information to the research participant (or parent/guardian) and to document
written informed consent, minor assent, and/or parental permission.
When written documentation is required, the researcher keeps the original, signed form.
Students may use this sample form or may copy ALL elements of it into a new document.
If the form is serving to document parental permission, a copy of any survey or questionnaire must be attached.
Student Researcher(s):
Title of Project: Tamarind (Tamarindus Indica) Seeds Coffee

I am asking for your voluntary participation in my science fair project. Please read the following information
about the project. If you would like to participate, please sign in the appropriate box below.

Purpose of the project:

If you participate, you will be asked to:

Time required for participation:

Potential Risks of Study:

Benefits:

How confidentiality will be maintained:

If you have any questions about this study, feel free to contact:

Adult Sponsor: ANN MARIE J. BALTAZAR Phone/email: 09155210945/annmarie_baltazar@yahoo.com

Voluntary Participation:
Participation in this study is completely voluntary. If you decide not to participate there will not be any negative
consequences. Please be aware that if you decide to participate, you may stop participating at any time and
you may decide not to answer any specific question.

By signing this form I am attesting that I have read and understand the information above and I freely
give my consent/assent to participate or permission for my child to participate.

Adult Informed Consent or Minor Assent Date Reviewed & Signed:


Printed Name of Research Participant: Signature:

Parental/Guardian Permission (if applicable) Date Reviewed & Signed: August 20, 2013

Parent/Guardian Printed Name: Signature:


P a g e | 24

CERTIFICATION AS TEAM PROJECT

THIS IS TO CERTIFY that the project submitted by

(Team Leader)

-______________________________________________________

(Member) (Member

Of Candon National High School as official entry to

(School)

2014-2015 Intel Philippine Science Fair was conducted/experimented by the abovementioned

Three (3) students.

ANN MARIE J. BALTAZAR

Printed Name and Signature of Adviser/Adult Sponsor

NOTED:

MRS. PACITA L. BASABAS Date Signed: ___________________

Printed Name and Signature of Principal or

Head of S and T Department


P a g e | 25

2011-2012 Intel Philippine Science Fair


RESEARCH PAPER

PART I: BACKGROUND INFORMATION

1. Students name Level:

2. a) Team Leaders Name Level:

b) Member Level:

c) Member Level:

3. School Candon National High School

4. School Address Bagani Campo, Candon City, Ilocos Sur

5. Telephone/Fax Numbers 742-6456

6. Title of Project Tamarind (Tamarindus Indica) Seeds Coffee

7. Project Adviser/Adult Sponsor Ann Marie J. Baltazar

8. This years experiment began and ended

9. Where did you conduct your lab work?(Check all that apply)

[ ] Research Institution [ / ] School

[ ] Field [ / ] Home

10. Name, address and phone no. of lab work site(s)

Candon National High School Laboratory, Bagani Campo, Candon City, Ilocos Sur
P a g e | 26

Republic of the Philippines

DEPARTMENT OF EDUCATION

Candon City

APPLICATION FORM TEAM PROJECT

Region: I

Please Check: Level: [ / ] Division [ ] Regional [ ] National

Cluster [ ]1 [ / ]2

Science Fair Division: [ / ] Life Sciences [ ] Physical Sciences

Field of Study/Discipline

1.
Name of Leader Surname First Name Middle Name

Name of Member Surname First Name Middle

Name of Member Surname First Name Middle

2. Permanent House Address

No. Street District City/Municipality Province

3. Telephone/Fax No. 4. Sex Female 5. Birth Date

6. School, Address of School CandonNHS, Bagani Campo, Candon City, Ilocos Sur
Tel. No./ Fax No. of School 742-6456 7. School Year Level

8. Title of the Investigatory Project Tamarind (Tamarindus Indica) Seeds Coffee

9. Attach one copy o f accomplished OFFICIAL ABSTRACT FORM: (Not more than 250 words, 1 page)

Noted: MRS. PACITA L. BASABAS

Printed Name and Signature of Printed Name and Signature of the Principal or Head of

Project Leader Science Department

Project Adviser/Adult Sponsor ANN MARIE J. BALTAZAR Date Submitted


P a g e | 27

CERTIFICATION OF PARENTAL CONSENT

We, who are legal

parents/ of with residence at do

hereby certify that we give our full support for our son/ daughter to participate in the 2013-

2014 Intel Philippine Science Fair, SCHOOL on under the

following conditions:

1. Our child will be chaperoned/ escorted by her/ his project adviser;

a. The chaperone will see to the safety, behavior and physical upkeep of our

child as far as humanly possible;

b. Considering the above conditions and the benefits that our child will

derive from his/ her participation in this activity, and realizing that every precaution

will be undertaken by the adviser/ chaperone and your office, we undersigned

parents/ guardian of the above name project investigator do hereby give our consent

for him/ her to participate in the 2010- 2011 Intel Philippine Science Fair. We shall

bring him/ her to the point of official debarkation.

Name & Signature of Father/ Guardian Name & Signature of Mother Date of signed
P a g e | 28

CERTIFICATION OF PARENTAL CONSENT

We, who are legal

parents/ of with residence at do

hereby certify that we give our full support for our son/ daughter to participate in the 2014-

2015 Intel Philippine Science Fair, SCHOOL on under

the following conditions:

1. Our child will be chaperoned/ escorted by her/ his project adviser;

a. The chaperone will see to the safety, behavior and physical upkeep of our

child as far as humanly possible;

b. Considering the above conditions and the benefits that our child will

derive from his/ her participation in this activity, and realizing that every precaution

will be undertaken by the adviser/ chaperone and your office, we undersigned

parents/ guardian of the above name project investigator do hereby give our consent

for him/ her to participate in the 2010- 2011 Intel Philippine Science Fair. We shall

bring him/ her to the point of official debarkation.

Name & Signature of Father/ Guardian Name & Signature of Mother Date of signed
P a g e | 29

CERTIFICATION OF PARENTAL CONSENT

We, who are legal

parents/ of with residence at

do hereby certify that we give our full support for our son/ daughter to participate in the

2014- 2015 Intel Philippine Science Fair, SCHOOL on under the

following conditions:

1. Our child will be chaperoned/ escorted by her/ his project adviser;

a. The chaperone will see to the safety, behavior and physical upkeep of our

child as far as humanly possible;

b. Considering the above conditions and the benefits that our child will

derive from his/ her participation in this activity, and realizing that every precaution

will be undertaken by the adviser/ chaperone and your office, we undersigned

parents/ guardian of the above name project investigator do hereby give our consent

for him/ her to participate in the 2010- 2011 Intel Philippine Science Fair. We shall

bring him/ her to the point of official debarkation.

Name & Signature of Father/ Guardian Name & Signature of Mother Date of signed
P a g e | 30

MEDICAL CERTIFICATE

Date:

THIS IS TO CERTIFY that ________________of Candon National High School has undergone physical

Examination (Name of Project Investigator) (School)

and was found to be physically fit to participate in the 2013-2014 Regional Intel Philippine Science Fair, on

(Date)

REMARKS :

________________

Examining Physician

License No:

Hospital/Clinic Office: CANDON NATIONAL HIGH SCHOOL CLINIC

Address: BAGANI CAMPO, CANDON CITY


P a g e | 31

MEDICAL CERTIFICATE

Date:

THIS IS TO CERTIFY that _________________of Candon National High School has undergone physical

Examination (Name of Project Investigator) (School)

and was found to be physically fit to participate in the 2014-2015 Regional Intel Philippine Science Fair, on

(Date)

REMARKS :

_______________

Examining Physician

License No: ____

Hospital/Clinic Office: CANDON NATIONAL HIGH SCHOOL CLINIC

Address: BAGANI CAMPO, CANDON CITY


P a g e | 32

MEDICAL CERTIFICATE

Date:

THIS IS TO CERTIFY that __________________of Candon National High School has undergone physical

Examination (Name of Project Investigator) (School)

and was found to be physically fit to participate in the 2014-2015 Regional Intel Philippine Science Fair, on

(Date)

REMARKS :

_____________
Examining Physician

License No: _________

Hospital/Clinic Office: CANDON NATIONAL HIGH SCHOOL CLINIC

Address: BAGANI CAMPO, CANDON CITY


P a g e | 33

CERTIFICATION AS OFFICIAL PROJECT ADVISER


This is to certify that MS. ANN MARIE J. BALTAZAR is the Official Project Adviser/Adult

(Name of Project Adviser)

Sponsor of project TAMARIND (TAMARINDUS INDICA) official entry of Candon National High School
to the 2014-2015 Regional Intel Philippine Science Fair. (School)

MRS. PACITA L. BASABAS_

Printed Name & Signature of Principal

Date Signed: _________