Scientific Creative Solutions Competition 2013 Form

7/30/2019 Scientific Creative Solutions Competition 2013 Form

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If you have any questions, contact the Secretariat for PM Awards for Scientific Ingenuity at:Telephone: (868) 758-3777 Fax: (868) 628-2069

E-mail: [email protected] or visit www.niherst.gov.tt.

INSTRUCTIONS

READ THE REGULATIONS CAREFULLY BEFORE FILLING OUT THIS FORM.

PLEASE TYPE OR PRINT NEATLY ALL INFORMATION.

IF A QUESTION IS NOT APPLICABLE TO YOUR SUBMISSION INDICATE BY N/A.

IF NECESSARY, ADDITIONAL PAGES AND DIAGRAMS MAY BE ATTACHED BY STAPLING. ALL ADDITIONALPAGES MUST BE NUMBERED. NO NAMES MUST BE WRITTEN ON THESE ADDITIONAL PAGES.

THE QUESTIONS ON THIS FORM ARE MEANT AS A GUIDE AND ENTRANT SHOULD EXPAND UPONANSWERS TO IMPROVE CLARITY.

THIS FORM IS FOR BOTH JUNIOR AND SENIOR ENTRANTS. JUNIOR ENTRANTS MUST WORK UNDER ANADULT SUPERVISOR.

EVERY JUNIOR ENTRANT MUST HAVE A PARENT OR GUARDIAN SIGN THIS FORM.

THIS FORM MUST BE SUBMITTED BY 4pm on MARCH 5TH, 2013.

Entrant #1 Data Entrant #2 Data

First Name/Middle: _________________________ First Name/Middle: _________________________

Last Name: _________________________ Last Name: _________________________Date of Birth: _________________________ Date of Birth: _________________________

Address: _________________________ Address: _________________________

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Citizenship: _________________________ Citizenship: _________________________

Tel: _________________________ Tel: _________________________

Fax: _________________________ Fax: _________________________

E-mail: _________________________ E-mail: _________________________

Previous Entrant: Yes (Year: ____ ) No Previous Entrant: Yes (Year: ____ ) No

Entrants Signature: _________________________ Entrants Signature: _______________________

Date: _________________________ Date: _______________________

For Junior Entrants (13-17 years old):

Parents Signature: _________________________ Parents Signature: _______________________

Date: _________________________ Date: _______________________

SCIENTIFIC CREATIVE SOLUTIONS COMPETITION

Entry Code/Number CS

PRIME MINISTERS AWARDS FOR SCIENTIFIC INGENUITY

OFFICIAL 2013 REGISTRATION FORM

STAGE 1


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Entrant #3 Data Entrant #4 Data

First Name/Middle: _________________________ First Name/Middle: _________________________

Last Name: _________________________ Last Name: _________________________

Date of Birth: _________________________ Date of Birth: _________________________

Address: _________________________ Address: _________________________

_________________________ _________________________

Citizenship: _________________________ Citizenship: _________________________

Tel: _________________________ Tel: _________________________

Fax: _________________________ Fax: _________________________

E-mail: _________________________ E-mail: _________________________

Previous Entrant: Yes (Year: ____ ) No Previous Entrant: Yes (Year: ____ ) No

Entrants Signature: _________________________ Entrants Signature: _______________________

Date: _________________________ Date: _______________________

For Junior Entrants (13-17 years old):

Parents Signature: _________________________ Parents Signature: _______________________

Date: _________________________ Date: _______________________

Name of School/Institution (if applicable): _________________________________________________________

Name of Witness (PRINT): _________________________

Signature of Witness: _________________________

Date: _________________________

Adult supervisors data (for junior entrants only)

Title _________________________ Home phone _________________________

First Name/Middle _________________________ Work Phone _________________________

Last Name _________________________ Fax Number _________________________

Address _________________________ Email _________________________

_________________________ Signature _________________________

_________________________ Date _________________________


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1. Outline the problem being addressed.

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2. Give a brief description of your proposed creative solution (no more than 500 words):

Please ensure that this description clearly satisfies the 3 judging criteria for this Stage as outlined on

Pg. 10 of the Regulations booklet:

Outline the Novel aspects of your solution (Originality)

Identify those who will be affected by your solution

Highlight some of the benefits of your proposed solution

Outline clearly the creative aspects of your solution (Ingenuity)

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DO NOT PLACE YOUR NAME OR OTHER IDENTIFICATION ON THIS PAGE


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3. What are some of the existing solutions to the problem you have identified, and how is your creative solution

different from these? Define the novel characteristics of your solution. (no more than 500 words)

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FOR OFFICIAL USE ONLY

Category

Age Group

Entry Code/Number


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INSTRUCTIONS

READ THE REGULATIONS CAREFULLY BEFORE FILLING OUT THIS FORM.

PLEASE TYPE OR PRINT NEATLY ALL INFORMATION.

IF A QUESTION IS NOT APPLICABLE TO YOUR SUBMISSION INDICATE BY N/A.

IF NECESSARY, ADDITIONAL PAGES AND DIAGRAMS MAY BE ATTACHED BY STAPLING. ALL ADDITIONALPAGES MUST BE NUMBERED. NO NAMES MUST BE WRITTEN ON THESE ADDITIONAL PAGES.

THE QUESTIONS ON THIS FORM ARE MEANT AS A GUIDE AND ENTRANT SHOULD EXPAND UPON

ANSWERS TO IMPROVE CLARITY.

THIS FORM IS FOR BOTH JUNIOR AND SENIOR ENTRANTS. JUNIOR ENTRANTS MUST WORK UNDER ANADULT SUPERVISOR.

EVERY JUNIOR ENTRANT MUST HAVE A PARENT OR GUARDIAN SIGN THIS FORM.

THIS FORM MUST BE SUBMITTED BY 4pm on MAY 17TH, 2013.

NAME OF ENTRANT (PRINT) SIGNATURE OF ENTRANT SIGNATURE OF PARENT DATE

1. ______________________ ________________________ _______________________ ________

2. ______________________ ________________________ _______________________ ________

3. ______________________ ________________________ _______________________ ________

4. ______________________ ________________________ _______________________ ________

NAME OF SCHOOL/ INSTITUTION (if applicable): __________________________________________________________

NAME OF WITNESS (PRINT): ________________________

SIGNATURE OF WITNESS: ________________________

DATE: ________________________

ADULT SUPERVISORS DATA (for Junior Entrants only)

Title ________________________ Home Phone ________________________First Name/Middle ________________________ Work Phone ________________________Last Name ________________________ Fax Number ________________________

Address ________________________ Email ________________________________________________ Signature ________________________________________________ Date ________________________




OFFICIAL 2013 DETAILED FORMSTAGE 2


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1. Clearly outline the problem you have identified or any problem that you foresee.

Indicate why this is seen as significant:

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2. Briefly describe how you have designed for the creative solution for the problem:

(Maximum of 1000 words)

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OFFICIAL USE ONLY

DO NOT WRITE IN THISSPACE


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3. Please identify the scientific or technological concepts employed in your creative

solution:

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4. What are some of the existing solutions to the problem you have identified, and

how is your creative solution different from these? Define the novel

characteristics of your solution.

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5. What are the materials required to realise your solution? Briefly explain your

choice of materials.

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6. What safety precautions have you taken into consideration, in designing your

solution?_________________________________________________________________

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OFFICIAL USE ONLY

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7. Who was your target population OR which sections of the population will benefit

most from your creative solution?

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8. What are the social, cultural or environmental benefits of your creative solution?

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9. Please add any other relevant information on your creative solution.

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OFFICIAL USE ONLY

DO NOT WRITE IN THIS

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I/We have read the rules contained in the regulations booklet of the awards scheme and I/We agree to abide by these rules.

I/We understand that an entry may be disqualified if there has been any false representation supplied by the entrant/s.

I/We understand that the organising committee is responsible for the selection of the judges, but is NOT answerable for theirdecision.

Submission of this signed form is a binding legal agreement that the entrant has accepted the judging process and that theJUDGES DECISION IS FINAL AND CONFIDENTIAL AND CANNOT BE CALLED INTO QUESTION.

Signature of Entrant(s) Signature of Parent/Guardian*

1 ________________________ Date ___________ 1 _________________________ Date _________

2 ________________________ Date ___________ 2 _________________________ Date _________

3 ________________________ Date ___________ 3 _________________________ Date _________

4 ________________________ Date ___________ 4 _________________________ Date _________

Signature of Mentor* _________________________ Date __________

Name of Witness _________________________

Signature of Witness _________________________ Date __________

*if applicable

ALL SIGNATURES ARE REQUIRED OR ENTRY IS DISQUALIFIED______________________________________________________________________________________________________



AGREEMENT


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DECLARATION OF ENTRANTS

(Applicable to both Scientific Creative Solutions & Scientific Innovation and Invention Competitions)


I/we, having submitted an entry for the Prime Ministers Awards for Scientific Ingenuity 2013 (the Awards), hereby represent andwarrant:

i. that I am/we are the sole creator(s) of the innovation / invention / creative solution submitted by me/us to the organisers of theAwards as my/our entry for the Awards;

ii. that to the best of my/our knowledge, actual and/or constructive, I/we have not committed any infringement of the intellectualproperty rights or any other rights of any third party or any applicable law in the process of my/our innovation / invention /creative solution; and

iii. that I/we have scrupulously adhered to the rules in the competition in the creation and submission of my innovation / invention/ creative solution for an Award.

I/We hereby acknowledge and agree that I/we will defend, indemnify and hold harmless NIHERST, the organisers and judges ofthe Awards and their respective directors, officers, employees, agents and representatives from all claims, actions, losses, liability,damages, costs and expenses arising from my/our breach of any infringement of any intellectual property rights or any other rightsof any third party or in breach of the rules of the Awards or any applicable law in the creation and submission of my/ourinnovation/invention/creative solution for an Award.

I/We agree also to promptly notify NIHERST, the organisers and judges of the Awards of any indemnifiable claim and to cooperatefully with NIHERST, the organisers and judges of the Awards in defending or settling such claim.


1 ________________________ Date ___________ 1 _________________________ Date _________

2 ________________________ Date ___________ 2 _________________________ Date _________3 ________________________ Date ___________ 3 _________________________ Date _________

4 ________________________ Date ___________ 4 _________________________ Date _________


Name of Witness _________________________


*if applicable





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AGREEMENT FOR JOINT OWNERSHIP IN

RESEARCH/INVENTION(Applicable to both Scientific Creative Solutions & Scientific Innovation and Invention Competitions)


We, the undersigned, in pursuance of our intended entry, as joint innovators/inventors, in the Prime Ministers Awards for ScientificIngenuity 2013, hereby individually and jointly agree as follows:

i. That we shall jointly research, design, develop and otherwise collaborate in the research/invention of for entry in the Competition.

ii. That we shall be joint owners of the innovation/invention/creative solution for all purposes.iii. That we shall record all research and technical activities in our inventors log, which will be classified and kept confidential.iv. That at the end of each work session, we shall all sign at the bottom of the page of the log entry and that either principal or

mentor shall witness our signatures. All signatures shall be dated.v. Any decision with respect to the seeking of intellectual property rights/patenting and commercialisation of our

innovation/invention/creative solution will be decided by consent of all.

vi. That we shall seek legal advice before any decision regarding the seeking of intellectual property rights/patenting andcommercialisation of our innovation/invention/creative solution is implemented.

We acknowledge that the disclosure to the public of information regarding our innovation/invention/creative solution, and inparticular, the inventive processes could be fatal to the seeking of Intellectual Property rights of our innovation/invention/creativesolution and consequently we agree to keep this information confidential.

With respect to ownership of the entry, please refer to the Official Regulations, Pg. 8:

Entrants Name Percentage of Ownership

1. ______________________________ ______________________________2. ______________________________ ______________________________3 ______________________________ ______________________________

4. ______________________________ ______________________________


1 ________________________ Date ___________ 1 _________________________ Date _________

2 ________________________ Date ___________ 2 _________________________ Date _________

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Name of Witness _________________________


*if applicable





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Scientific Creative Solutions Competition 2013 Form

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Transcript of Scientific Creative Solutions Competition 2013 Form