ISEF Form_pdf version

7/10/24, 6:06 PM

U.S. Agency for International Development (USAID) Science Champion Award for International Science and Engineering Fair (ISEF…

U.S. Agency for International
Development (USAID) Science Champion
Award for International Science and
Engineering Fair (ISEF)-Affiliated Fairs:
Winning Project Submission Form 
Office of Management and Budget (OMB) Number: XXXXXX
Expiration Date: XXXXX
Instructions: 
Please fill out the below information as soon as possible after the conclusion of your
International Science and Engineering Fair (ISEF)-Affiliated Fair. Email
[email protected] with any questions. 
The information collected in this form will provide accurate accounting of all recipients of
the United States Agency for International Development (USAID) Science Champion Award
for ISEF-Affiliated Fairs. This data collection will enable USAID staff to issue the invitation
to the virtual conversation with USAID to all recipients. Public reporting for this collection
of information is estimated to be approximately five minutes per response.
Privacy Notice:
This survey is administered by the USAID Research Division's Fellowships Team, in the
Innovation, Technology, and Research (ITR) Hub in the Bureau for Inclusive Growth, 
Partnerships, and Innovation (IPI). Completion of this survey is voluntary. You may choose
to respond to all or any of the questions. Your participation will help ensure adequate
representation in the final results and outcomes. If you agree to participate, you may
withdraw your participation in the survey at any time by simply exiting the survey. For more
information, please contact [email protected]. 
As a reminder, please do not include any unsolicited Personally Identifiable Information in
response(s).
Paperwork Reduction Act Statement:
A federal agency may not conduct or sponsor, and a person is not required to respond to,
nor shall a person be subject to a penalty for failure to comply with, a collection of
information subject to the requirements of the Paperwork Reduction Act unless that
collection of information displays a currently valid Office of Management and Budget
(OMB) Control Number. The OMB Control Number for this information collection is
XXXXXXX. Public reporting for this collection of information is estimated to be
approximately five minutes per response.
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U.S. Agency for International Development (USAID) Science Champion Award for International Science and Engineering Fair (ISEF…

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* Indicates required question

Email *
Your email

Form Submitter's Name *
Your answer

Affiliated Fair Number *
For Example: USAL01
Your answer

Fair Name *
Your answer

Fair Date(s)  *
MM/DD/YY
Your answer

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U.S. Agency for International Development (USAID) Science Champion Award for International Science and Engineering Fair (ISEF…

Fair Location *
City/State/Country
Your answer

Fair Director Name *
Your answer

Fair Director Email Address *
Your answer

About The Winning Project

Project Name *
Your answer

Brief Project Description *
1-2 sentences only
Your answer

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U.S. Agency for International Development (USAID) Science Champion Award for International Science and Engineering Fair (ISEF…

Team or Individual Winner? *
Individual
Team

Student Name(s) *
Note: If multiple students, please list student names and other information requested below
in the same order.
Your answer

Student Grade Level(s) *
Your answer

Student School Name(s) *
Your answer

Student School Location(s) *
Your answer

Student Email Address(es) *
Your answer

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U.S. Agency for International Development (USAID) Science Champion Award for International Science and Engineering Fair (ISEF…

Student's Advisor Name *
Your answer

Student's Advisor Email Address *
Your answer

I have received consent from the parents/guardians of this/these student(s) to

*

collect this information and share it with USAID for the purpose of
communicating about the Science Champion Award.
Yes

Send me a copy of my responses.

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