YSAP Student Application Form
Application Forms DUE December 1, 2014
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Name of High School *
Name of Teacher (First Name Last Name) *
Teacher Email *
Teacher Cell Phone *
Student 1 (First Name) *
Student 1 (Last Name) *
Student 1 Email Address *
Student 1 Gender (Check One) *
Student 1 - Racial Category *
Check as many as apply to you
Student 1: Obtained Parents Permission to Participate in YSAP Program? *
Student 1: Obtained Parents Approval for Video Release (see below) *
"Video Consent and Release  I (“Participant”), hereby consent and grant to the Young Science Achievers Program® (YSAP®) the full and continuing right to use any and all photographs and/or motion pictures of me and also the recordings of my voice, if any, for any purpose related to the Young Science Achievers Program (collectively the “Materials”).  I further agree that any and all Materials may be edited, reproduced, and presented in any way deemed proper by the YSAP® without additional consent from me, or payment to me or anyone on my behalf claiming to have right to such payment, and such Materials may be used with or without my name. I also agree that YSAP may assign or license all of the rights herein granted and that the Materials may be copyrighted by YSAP®, its assigns, or licensees without any obligation to pay royalties or fees to me or anyone in my behalf claiming to have rights to such fees for whatever reason.  I hereby agree to release and to hold harmless the YSAP®, and any of their directors, trustees, supporters, officers, representatives, members, agents and employees from all claims of every kind on account of such use."
Student 1 ( Street Address) *
Student 1 (City) *
Student 1 (State) *
(use two letter abbreviation)
Student 1 (Zip Code) *
Student 2 (First Name)
Student 2 (Last Name)
Student 2 Email Address
Student 2 Gender (Check One)
Clear selection
Student 2 - Racial Category
Check as many as apply to you
Clear selection
Student 2: Obtained Parents Permission to Participate in YSAP Program?
Clear selection
Student 2: Obtained Parents Approval for Video Release (see below)
"Video Consent and Release  I (“Participant”), hereby consent and grant to the Young Science Achievers Program® (YSAP®) the full and continuing right to use any and all photographs and/or motion pictures of me and also the recordings of my voice, if any, for any purpose related to the Young Science Achievers Program (collectively the “Materials”).  I further agree that any and all Materials may be edited, reproduced, and presented in any way deemed proper by the YSAP® without additional consent from me, or payment to me or anyone on my behalf claiming to have right to such payment, and such Materials may be used with or without my name. I also agree that YSAP may assign or license all of the rights herein granted and that the Materials may be copyrighted by YSAP®, its assigns, or licensees without any obligation to pay royalties or fees to me or anyone in my behalf claiming to have rights to such fees for whatever reason.  I hereby agree to release and to hold harmless the YSAP®, and any of their directors, trustees, supporters, officers, representatives, members, agents and employees from all claims of every kind on account of such use."
Clear selection
Student 2 ( Street Address)
Student 2 (City)
Student 2 (State)
(use two letter abbreviation)
Student 2 (Zip Code)
Student 3 (First Name)
Student 3 (Last Name)
Student 3 Email Address
Student 3 Gender (Check One)
Clear selection
Student 3 - Racial Category
Check as many as apply to you
Clear selection
Student 3: Obtained Parents Permission to Participate in YSAP Program?
Clear selection
Student 3: Obtained Parents Approval for Video Release (see below)
"Video Consent and Release  I (“Participant”), hereby consent and grant to the Young Science Achievers Program® (YSAP®) the full and continuing right to use any and all photographs and/or motion pictures of me and also the recordings of my voice, if any, for any purpose related to the Young Science Achievers Program (collectively the “Materials”).  I further agree that any and all Materials may be edited, reproduced, and presented in any way deemed proper by the YSAP® without additional consent from me, or payment to me or anyone on my behalf claiming to have right to such payment, and such Materials may be used with or without my name. I also agree that YSAP may assign or license all of the rights herein granted and that the Materials may be copyrighted by YSAP®, its assigns, or licensees without any obligation to pay royalties or fees to me or anyone in my behalf claiming to have rights to such fees for whatever reason.  I hereby agree to release and to hold harmless the YSAP®, and any of their directors, trustees, supporters, officers, representatives, members, agents and employees from all claims of every kind on account of such use."
Clear selection
Student 3 ( Street Address)
Student 3 (City)
Student 3 (State)
(use two letter abbreviation)
Student 3 (Zip Code)
Student 4 (First Name)
Student 4 (Last Name)
Student 4 Email Address
Student 4 Gender (Check One)
Clear selection
Student 4 - Racial Category
Check as many as apply
Clear selection
Student 4: Obtained Parents Permission to Participate in YSAP Program?
Clear selection
Student 4: Obtained Parents Approval for Video Release (see below)
"Video Consent and Release  I (“Participant”), hereby consent and grant to the Young Science Achievers Program® (YSAP®) the full and continuing right to use any and all photographs and/or motion pictures of me and also the recordings of my voice, if any, for any purpose related to the Young Science Achievers Program (collectively the “Materials”).  I further agree that any and all Materials may be edited, reproduced, and presented in any way deemed proper by the YSAP® without additional consent from me, or payment to me or anyone on my behalf claiming to have right to such payment, and such Materials may be used with or without my name. I also agree that YSAP may assign or license all of the rights herein granted and that the Materials may be copyrighted by YSAP®, its assigns, or licensees without any obligation to pay royalties or fees to me or anyone in my behalf claiming to have rights to such fees for whatever reason.  I hereby agree to release and to hold harmless the YSAP®, and any of their directors, trustees, supporters, officers, representatives, members, agents and employees from all claims of every kind on account of such use."
Clear selection
Student 4 ( Street Address)
Student 4 (City)
Student 4 (State)
(use two letter abbreviation)
Student 4 (Zip Code)
Student 5 (First Name)
Student 5 (Last Name)
Student 5 Email Address
Student 5 Gender (Check One)
Clear selection
Student 5 - Racial Category
Check as many as apply
Clear selection
Student 5: Obtained Parents Permission to Participate in YSAP Program?
Clear selection
Student 5: Obtained Parents Approval for Video Release (see below)
"Video Consent and Release  I (“Participant”), hereby consent and grant to the Young Science Achievers Program® (YSAP®) the full and continuing right to use any and all photographs and/or motion pictures of me and also the recordings of my voice, if any, for any purpose related to the Young Science Achievers Program (collectively the “Materials”).  I further agree that any and all Materials may be edited, reproduced, and presented in any way deemed proper by the YSAP® without additional consent from me, or payment to me or anyone on my behalf claiming to have right to such payment, and such Materials may be used with or without my name. I also agree that YSAP may assign or license all of the rights herein granted and that the Materials may be copyrighted by YSAP®, its assigns, or licensees without any obligation to pay royalties or fees to me or anyone in my behalf claiming to have rights to such fees for whatever reason.  I hereby agree to release and to hold harmless the YSAP®, and any of their directors, trustees, supporters, officers, representatives, members, agents and employees from all claims of every kind on account of such use."
Student 5 ( Street Address)
Student 5 (City)
Student 5 (State)
(use two letter abbreviation)
Student 5 (Zip Code)
Title of Project *
Field of Study *
(Check all that apply)
Project Description *
Describe the problem or research topic to be studied and your proposed method(s). Describe the "big picture" behind your project. For example, why is your project important or how will it impact society or science, technology, engineering or mathematics? MAX 250 words
Background of Project *
Provide details about the hypothesis, methods or designs to be used, and variables.  MAX 250 words
Experimental Description of Project *
Specifically describe what you plan on doing. Give specific details about what data and how it will be taken, and if possible, explain the analysis you plan to do. MAX 250 words
Planned Expenditure of Funds for Project *
Provide a detailed budget for what you will need for the project and why. Include model, brand, and price.
Total Funds Being Requested from YSAP for Project *
(Round to the nearest dollar. DON'T INCLUDE DOLLAR SIGN or CENTS)
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