DEPARTMENT OF CHEMISTRY & BIOCHEMISTRY
PROPOSAL FOR HIGH SCHOOL STUDENT RESEARCH
Student’s Last Name: ____________________
First Name:___________________
Current School:_________________________
Date of birth (restrictions vary for age 14-15, 16-17 and 18+):_____________
Start Date:_______________________
End Date:_______________________
Laboratory room(s) above student will be working:_______________________
Description of work the above student will be doing:
Attach additional pages as necessary.
Name of daily supervisor:______________________________________
Job title of daily supervisor:_____________________________________
Contact number of daily supervisor:______________________________
Signature - Student Participant:_________________________________Date________
Signature - Parent/Guardian:___________________________________Date________
Parent or Guardian signature required if participant is under 18 years of age.
Signature - Sponsoring Faculty Member: _________________________Date________
Signature - Department Chair/Co-Chair:__________________________Date________
Signature - Building Manager:__________________________________Date________
Please retain a copy for administrative files, send a copy to laboratory manager and
send completed original to Building Manager.
Amended 06/22/2010.