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GCS Science Project and Research Plan Approval Form
Student, parent, teacher and adult sponsor must complete this form and have the project
approved before the student starts any experimentation.
Please print or type information
Student Name _______________________________________________ Grade___________________
School ____________________________________________________
Project Title: ________________________________________________________________________
Name(s) of other teammates with this project: (1.) ___________________________________________
(2.) ____________________________________ (each teammate in a group project must complete this form)
Teacher Name: __________________________ Parent/Guardian Name: ________________________
Where project is conducted: (check all that apply) Home ____ School _____ Field (park, farm, mall)
_____ Research Institution _____ Other (specific) ______________________________
Date of Student Acknowledgement: I understand the risks and possible dangers of the proposed
research plan. This projects are my own work. Initial: _____________ Date: ________________
Date of parent/guardian approval: I have read and understand the risks and possible dangers involved in
the research plan. I consent to this student participating in this project. Initial: __________ Date: ______
Date of teacher approval: I have read and understand the risks and possible dangers involved in the
research plan. Date of review of research plan: Initial: ______________ Date: __________________
Adult sponsor name: ________________________________ Phone number ____________________
Email ___________________________________ Date research plan reviewed: __________________
(Adult sponsor may be teacher, parent, community adult or professional scientist who is responsible for working with
students, evaluate possible risks, and ensure rules are followed)
Attach the student research plan to this form.
Please check any of the statements below that apply. If any of the statements below are checked, other forms will
be required.
_____ Project uses animals
_____ Project includes human for a survey, test, observations, etc.
_____ Project includes microorganism (middle and high grades only) (includes molds, or fungi,
bacteria, small pond organisms, compost, viruses, etc.)
_____Project includes potentially hazardous biological agents (human/animal fresh or frozen, teeth,
manure, urine, blood, other body fluids, or recombinant DNA)
_____ Project includes potentially hazardous activities chemical (weapons, projectiles, chemicals, power
tools, open flame or high heat, etc.)
A qualified scientist and review committee may be required for these types of high risk projects.
Additional forms attached (names or number): ____________________________________________