Mid-Columbia Science and Engineering Fair

Registration

Please fill out as completely as possible. Required fields have been marked with an *.

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Project Information:

*Project Title: ________________________________________________

Choose a subcategory from the Area you would like your project to be judged in.

Physical Sciences:	Life Sciences:
Chemistry	Behavioral
Computers	Biochemistry
Earth and Space	Botany
Engineering	Environmental
Environmental	Health
Mathematics	Microbiology
Physics	Zoology

Estimate total number of hours worked on project: (0-500) ________

Estimate the percent of work done by you: (0-100) ________

*Will your exhibit require an electrical outlet (110 volt only)? Yes / No

Did your project require SRC/IRB approval? Yes / No

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Student Information:

*First Name: ______________

*Last Name: ______________

*Street Address: _____________________________________

*City: ________________ *State: ______ *ZIP Code: _________

*Phone: __________________

E-mail Address (optional): ___________________________________

*Grade: _________

School Information:

*School: ___________________________ *Teacher: __________________________

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Special Awards Information:

The following information is requested on a strictly voluntary basis. This information will not be used in the main science fair judging, but may assist in the determination of eligibility for special awards.

Gender: __________

Heritage: (Please select a primary heritage, then (if necessary) a secondary, from the following list.)

African American / Asian / Caucasian / Hispanic / Native American / Pacific Islander

Primary: _________________________ Secondary: _________________________

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*Purpose: (no more than 25 words)