Barcode Long Island Campaign Proposal Form

Please fill in all information below to participate in a Barcode Long Island campaign.

Note that collection locations are not guaranteed, but will be approved on a first come, first served basis. Multiple teams from a school are welcome to be a part of campaigns, but must fill out separate proposal forms. In this case, please be sure teams collect visibly different organisms, collect from different locations, and/or participate in different campaigns. Teams that participate in a campaign are strongly encouraged to collect 20 samples. Biographies for all team members must also be submitted with this form.

Team Name:

Project Title:

Team Members:

School:

Campaign (please select one):

__ __ Beetles __ __ Ants __ __ Mosquitoes __ __ Marine worms (NOT terrestrial worms) __ __ Aquatic (freshwater) macroinvertebrates (ex: insect larvae)

Collection Location(s) – please describe:

Latitude: Longitude:

Briefly describe your project goals, and relevance to human health: Please describe the collection methods for your samples:

For each team member and mentor, please include the following information:

Student 1

Name:

Present grade (9th, 10th, 11th or 12th grade):

School/institution:

State/ZIP:

Brief biography:

Student 2

Name:

Present grade (9th, 10th, 11th or 12th grade):

School/institution:

State/ZIP:

Brief biography:

Student 3 (if applicable)

Name:

Present grade (9th, 10th, 11th or 12th grade):

School/institution:

State/ZIP:

Brief biography: Student 4 (if applicable)

Name:

Present grade (9th, 10th, 11th or 12th grade):

School/institution:

State/ZIP:

Brief biography:

Mentor

Name:

School/institution:

State/ZIP:

Brief biography: