New Haven Science Fair 2008

9-12 High School Registration Form

(Please Print/Type NEATLY)

For Office Use Only

Media Release Form Signed? Check one: “ Yes “ No

SRC Approved? Circle one: “ Yes “ No-if applicable

If no, please explain: ________________________________________________________________________________________

School Name__________________________Phone___________________Fax_______________________

Category: “ Biological Check one: “ Physical

Check one: “ Individual “ Team Entry

Grade level: check one: “ Gr. 9 “ Gr. 10 “ Gr. 11 “ Gr. 12

Project Title

Brief Project Description

________________________________________________________________________________________

Individual Entry/Team Leader
Student’s Name	HR
Home Address	Home Telephone
School	School Telephone
Sponsoring Teacher	Teacher’s Telephone
Mentor’s Name	Mentor’s Affiliation
Student’s Signature	Date
Parent/Guardian Signature	Date

Team Entry
Second Team Member
Student’s Signature	Date
Parent/Guardian Signature	Date

Note: Team size is limited to a maximum of two students at the high school level.

Single entry applicants should just fill in the lead student section of the form.

Display needs electricity? check one	“ Yes “ No	Bilingual interpreter needed for judging? check one	“ Yes “ No
If display needs electricity, please bring a grounded extension cord. Electrical power will only be provided for finalist judging.

NOTE: Your signature on this form releases the New Haven Public Schools and other partners of the New Haven Science Fair

Program from any liability for loss or damage to projects during the setup, judging and exhibition period of the Science Fair.

Deadline for filing application – is Friday, April 11, 2008 No applications will be accepted late!

Please return completed form to:

Mr. Richard Therrien, Science Supervisor K-12, NHPS

Gateway Center, 3^rd floor, 54 Meadow St. or you may FAX your registration form to 946-8664, science.fair@new-haven.k12.ct.us