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STATE SCIENCE FAIR VERIFICATION FORM
I do plan to attend the 54 th Annual Florida State Science and Engineering Fair to be held in
Lakeland. Florida, on April 15 -18, 2009.
Please Type or Print
Name:_____________________________________________ Home Phone:_________________
(Last) (First)
Home Address:__________________________________________________________________
(Street) (City) (Zip)
School Name:__________________________________________________________________
Research Teacher: ______________________________________________________________
Name of Parent/Guardian: _________________________________________________________
Division Sex
Grade in School: ______ Junior Senior M F
Category Entered:__________________________________________________________________
Project Type: Floor Table Electricity Required: Yes No
Note: There is a $70.00 charge for electrical hookup payable to FFFS
My student will travel as a member of Brevard’s Official delegation: Yes No
(Chaperones will only supervise members of the official delegation and students will not be added to the official party)
We understand the State Science Fair Policies, Procedures and Guidelines: Yes No
My student will bring to the state competition, all of the original forms to the state science fair.
Yes No
The research teacher has copies of all registration and entry materials (including my protocol):
Yes No
My parent/guardian and I have supplied the Medical and Special Information requested on the back
of this form: Yes No
We have attached a check for $145.00 payable to Brevard Schools Foundation/ Science Fairs
Yes No
I have attached a check for $70.00 payable to Florida Foundation for Future Scientists (electricity):
Yes N/A
____________________________ _______________________________________
Student Signature Parent /Guardian Signature
__________________________________
Research Teacher Signature
Due to Fair Director: 3 days after the regional fair
February 4 (South) February 11 (Intracoastal) February 17 (Mainland)
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