Qualified Scientist

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Qualified Scientist Form (2) May be required for research involving human participants, vertebrate animals, potentially hazardous biological agents, and hazardous substances and devices. Must be completed and signed before the start of student experimentation. Student’s Name(s) Title of Project To be completed by the Qualified 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 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. Hazardous substances and devices Yes No 3. Will this study be 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? b. Experience/Training of the Designated Supervisor: To be completed by the Qualified Scientist: To be completed by the Designated Supervisor when the Qualified Scientist cannot directly supervise. I certify that I have reviewed and approved the Research Plan/ Project Summary prior to the start of the experimentation. If the I certify that I have reviewed the Research Plan/Project Summary student or Designated Supervisor is not trained in the necessary and have been trained in the techniques to be used by this student, procedures, I will ensure her/his training. I will provide advice and and I will 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/Project Summary. I understand that a Designated Supervisor is required when the student is not conducting experimentation under my Designated Supervisor’s Printed Name direct supervision. Signature Date of Approval (mm/dd/yy) Qualified Scientist’s Printed Name Signature Date of Approval (mm/dd/yy) Phone Email Page 36 International Rules: Guidelines for Science and Engineering Fairs 2020–2021, societyforscience.org/ISEF.

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