66th GREATER KANSAS CITY SCIENCE & ENGINEERING FAIR

Official Senior Division (Grades 9-12) Application--- April 5-8, 2017

All applications must be on this form. Please fill in all requested information.
Use pen or type information in all spaces. Please print clearly. ____________
Student Name (1)__________________________________________________________ Exhibit No.
(Student 1 if you have entered the GKCSEF more than once, please check the grades when you entered) (for SP office
4 5 6 7 8 9 10 11 use only)
Current grade level: 9 10 11 12
Parents/ Guardian Name(s)_______________________________________________
Parents/Guardian Email__________________________________ Home/Cell Phone(_____)______________
Home Address___________________________________________________________________________
(Street) (City) (State) (Zip)
Project Title:___________________________________________________________________________________

_______________________________________________________________________________________________
Project is being entered as: Individual Team, # on team ______ (Max of 3 students)
Names of Team Members (2)____________________________________(3)_______________________________
(If a team project)
Sponsor/Teacher _________________________________________________________________
(First & Last name)
Sponsor/Teacher Email___________________________________________________________

School___________________________________________________District_______________________________
School Address_______________________________________________________________________________
(Street) (City) (State) (Zip)
School Phone (______)________________________ Alternative Phone (_____)___________________

Note New Categories

Check Category: Animal Science (AS) Behavioral/Social Science (BE) Chemistry (CH) Chemical Energy (CE)
Computational Science, Bioinformatics & Math (CM) Computer Systems, Electronics & Robotics (CS)
Earth & Environmental Science (EA) Energy & Environmental Engineering (EE) Engineering Mechanics (EM)
Materials Science (MS) Microbiology(MI) Molecular Bio/Chem & Health Science (MO)
Physics & Astronomy (PA) Plant Science (PS)

Demographic Information (necessary for program assessment): Sex: Male Female

Ethnicity: Caucasian Asian African American Hispanic American Indian or Pacific Islander Multi-racial
Electrical Outlet: Yes Note: Check only if you need electricity for your project & enclose $50 fee. _____(for SP use only)

Please attach to application: Abstract (experimental project) or Description (engineering project)

An abstract should be 1-2 paragraphs and include the Title, Problem, Hypothesis, a short Procedure, along with
the Results and Conclusion (if completed).
Remember: The information you provide in this abstract is the primary deciding factor used by the review committee regarding your project.
EXHIBIT SIZE: Maximum size is 76 cm (30") deep X 122 cm (48") wide

Mentors/Professional Advisors Name and Company (if applicable):

_________________________________________
(Note: This information has no effect on your consideration as an applicant to enter the Greater Kansas City Science & Engineering Fair. It is
for tracking purposes only.)

Certification Forms - check all that apply. A completed copy of all forms indicated must accompany application.

ENTRIES NOT HAVING PROPER AND COMPLETE CERTIFICATION FORMS WILL BE REJECTED
ALL Senior Projects Must Include the Following Forms:
Adult Sponsor Checklist (1) ....Must be completed prior to experimentation.
Student Checklist (1A).....Make sure to correctly insert the dates that experimentation began and ended.
Approval Form (1B) ...Must be completed prior to beginning experimentation.
Senior projects may also need the following forms: Consult the SP website at www.sciencepioneers.org.
Regulated Research Institutional Industrial Setting (1C) To be completed by the supervising adult after experimentation.
Qualified Scientist (2) . Required for research involving human subjects, vertebrate animals
potentially hazardous biological agents, and DEA-controlled
substances.
Risk Assessment (3) ... Required for projects using hazardous chemicals, activities or
devices or regulated substances.
Human Participants (4).. ...Required for all research involving humans. IRB approval before
experimentation.
Vertebrate Animal Form (5A & 5B).. Required for all research involving vertebrate animals. SRC approval
before experimentation.
Potentially Hazardous Biological Agents/ Risk ....Required for all research involving microorganisms, rDNA and
Assessment (6A) fresh/frozen tissue, blood and body fluids. SRC/IACUC/IBC/RAC
approval required before experimentation.
Human & Vertebrate Animal Tissue (6B)................. Required for all projects using fresh/frozen tissue, primary cell
cultures, blood, blood products and body fluids. If the research
involves living organisms, please ensure that the proper human or
animal forms are completed.
ALL PROJECTS USING ANY TISSUE LISTED ABOVE, MUST ALSO COMPLETE FORM 6A.
Project Continuation (7)..Required for projects being continued from previous year
Prior approval to enter Fair (non-school sponsored).... Required for all projects entering Fair not associated with a school,
excluding home schools. Questions, call 816.460.2261.
ENTRY AGREEMENT
I (we), the undersigned, have read and understand the following:
The only ISEF - eligible fair this project will be entered into is the Greater KC Science & Engineering Fair.
Applications not having proper and complete certification forms will not be accepted.
The use of vertebrate animals during the development testing of the project is not allowed.
Science Pioneers, Inc. is not responsible for loss or damage of any exhibit while it is on display.
Projects are to be picked up Friday, April 7, 2017 at Union Station from 4:00 to 7:00 pm.
Projects not picked up by 7:00pm will be discarded. Science Pioneers cannot store projects that are left.

Student 1 Signature (Required)___________________________________________

Student 2 (if team project)________________________________________________

Student 3 (if team project)____________________________________________

Science Pioneers routinely takes photos of its events for program promotion. Your signature gives approval for your childs
photo to be used by Science Pioneers in conjunction with its charitable and educational purposes.

Parent/ Guardian Signature (Required)___________________________________________

For Sponsor/Teacher only:
I, the teacher, certify that to the best of my knowledge this entry is the work of the person(s) whose name(s) appear above.
I have reviewed this entry form and find all information and forms to be filled out completely and properly.
Entry fee of $6.00 is enclosed
______________________________________________
Signature of Sponsor/Teacher (Required)

Mail application form and $6.00 fee to: (One check per school please)
SCIENCE PIONEERS, INC.
Union Station This application, fee(s) & all forms must be received in our offices by
30 W. Pershing Friday, February 24, 2017 at 5:00 p.m. NO EXCEPTIONS.
Kansas City, MO 64108

2017 Greater Kansas City Science & Engineering Fair & Awards Ceremony will be
held at Union Station.