SOUTHERN CALIFORNIA JUNIOR SCIENCE AND HUMANITIES SYMPOSIUM, 2018

PROJECT PROPOSAL / STUDENT INFORMATION FORM 

This document must be completed by ALL students.  All fields must be completed

Those students whose project  involves (even if only observing) human subjects, invertebrate  or non­

human vertebrate animals, recombinant DNA, tissues, pathogenic agents, or controlled substances will

need to complete additional forms provided later by the program.

This form must be completed and filed no later than December 15, 2017.

If you have any questions, please contact Ann Miller at amiller@uci.edu.

When completed, email this form to:  Ann Miller   amiller@uci.edu  

Student's Name:  ______________________________________________________________________

Name of School:  ______________________________________Grade level:       
               
               
               

Home/Mobile Phone #:  _________________________________________________________________

Email address:  _______________________________________________________________________

Where did you conduct your experimentation?

At school: ______ At home: ______ In the field: ______

At a research institution: e.g. university lab, medical center, industrial setting:  ________

Name of Research Institution:                                                                                                                    

Lead Researcher’s signature: 
                                                                                                                       

Check here _____ if your project involves humans. 

Check here _____ if your project involves non­human vertebrates

Check here _____ if your project involved bacteria or invertebrates 

Check here _____ if your project involves recombinant DNA, pathogenic agents, or controlled 

Check here _____ if your project involves human or animal 

Name of current High School Science Teacher:                                                                                            

Teacher’s email address:                                                                                                                                
Teacher’s Signature:                                                               Date:                                                              

Student's Signature:  _________________________________ Date:  _____________________________