CARSEF 2019 STUDENT Project Entry Form
Please have all necessary information before beginning this form. It is important to complete this form for EACH student, including those working as a team. In addition to this completed registration form emailed to you, all required ISEF forms should be mailed, along with the student entry fee of $20 (no cash, please) for each student (not project) to:

UALR STEM Center - ETAS #125
c/o Keith Harris
2801 S. University Ave.
Little Rock, AR 72204.

Please make checks payable to UA Little Rock CARSEF 2019.

Registration forms must be submitted by February 15, 2019 to be eligible for CARSEF 2019. If you have any questions, please contact krharris@ualr.edu.

Thanks! We look forward to seeing you March 1, 2019!

Email address *
Student and Project Information
Division *
Category *
Mark the category that most accurately describes your project.
Does this project display need to sit on the floor? (Is it too large to sit on the regular table?) *
Does your project involve vertebrate animals? *
Does your project involve Human Participants?
Does your project involve Potentially Hazardous Biological Agents (PHBAs)? Research using microorganisms (including bacteria, viruses, viroids, prions, rickettsia, fungi, and parasites), recombinant DNA (rDNA) technologies or human or animal fresh/frozen tissues, blood, or body fluids may involve potentially hazardous biological agents. (See ISEF rules for complete list and more information)
Did you have a mentor on this project? *
If yes, list full name of mentor(s). *
Your answer
Is your project an individual or team project? *
TEAM Projects
If a Team Project, complete addition Student Team Members' Information below.
If not a TEAM Project, skip the section for Students #2, #3 and #4.
Project Title *
Your answer
Project Abstract (250 words or less) *
Your answer
Student First Name *
Your answer
Student's Middle Name *
Your answer
Student's Last Name *
Your answer
Student's Email *
Your answer
Gender *
Grade *
Student's Street Address *
Your answer
Student's City, State and Zip Code *
Your answer
Student #2 First Name of 2nd Team Member
Your answer
Student #2 Last Name of 2nd Team Member
Your answer
Student #2 Gender of 2nd Team Member
Student #2 Grade of 2nd Team Member
Student #2 Street Address of 2nd Team Member
Your answer
Student #2 City, State and Zip Code of 2nd Team Member
Your answer
Student #3 First Name of 3rd Team Member
Your answer
Student #3 Last Name of 3rd Team Member
Your answer
Student #3 Gender of 3rd Team Member
Student #3 Grade of 3rd Team Member
Student #3 Street Address of 3rd Team Member
Your answer
Student #3 City, State and Zip Code of 3rd Team Member
Your answer
Student #4 First Name of 4th Team Member
Your answer
Student #4 Last Name of 4th Team Member
Your answer
Student #4 Gender of 4th Team Member
Student #4 Grade of 4th Team Member
Student #4 Street Address of 4th Team Member
Your answer
Student #4 City, State and Zip Code of 4th Team Member
Your answer
TEACHER AND SCHOOL INFORMATION
Enter your teacher and school information below.
Teacher's First Name *
Your answer
Teacher's Last Name *
Your answer
Teacher's Email *
Your answer
School Phone *
Your answer
Teacher's Cell Phone
Your answer
District's Name *
Enter name of School District.
Your answer
School Name *
If you selected "Other" for School Name, enter name School below.
Your answer
School's Street Address *
Your answer
School's City, State and Zip Code *
Your answer
PAYMENT INFORMATION
Please specify method of Payment. "Check #", "PO #" or "Other" for your payment method. *
Enter "Check # or "PO #" *
Please enter the Check or Purchase Order # being submitted for payment of the registration fee. If not known, enter "unknown". Remit registration fee payment of $20 and forms to: UALR STEM Center ETAS #125 c/o Keith Harris 2801 S. University Ave. Little Rock, AR 72204
Your answer
Enter First and Last Name of Student Leader for this project below. *
Student Leaders name should be included on form of payment.
Your answer
Forms and Payment Submission
In addition to the completed registration form emailed to you, please mail all required ISEF forms, along with the entry fee of $20 (no cash, please) for each student (not project) to:

UALR STEM Center - ETAS #125, c/o Keith Harris, Director, 2801 S. University Ave., Little Rock, AR 72204.

A copy of your responses will be emailed to the address you provided.
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