Ronald Reagan Science Expo Interest Form

Interest Form Final Due Date: January 17, 2020

Science Fair: Wednesday, February 12, 2020
Please complete this form and return to your science teacher as soon as possible.
Up to 3 students may work together.
All interest forms must include parent signature(s).

Please also submit protocol forms for research involving humans, vertebrate animals, biological
materials (microorganisms or tissue), or potentially hazardous chemicals, activities or devices, if
applicable. These must be approved PRIOR to conducting research.

Student 1: Full name ____________________________________________

Kaiwan Bilal Student ID: _________________
645681

Grade ________
7 Date of Birth ______________________
October 28, 2007 Science Teacher _____________________
Johnathan McCoy

Student 2 (optional): Full name ________________________________________ Student ID: ______________

Grade ________ Date of Birth ______________________ Science Teacher _____________________

Student 3 (optional): Full name ________________________________________ Student ID: ______________

Grade ________ Date of Birth ______________________ Science Teacher _____________________

Project Title:( The Effect of IV on DV)

Pepto...Bismuth? (The Effect of Changing Pepto-Bismol Variations on the Amount of Bismuth

Choose your project category from the following: (Click here or visit the Science Expo website for category descriptions)
__Animal Sciences(AS)* __Earth and Planetary Sciences(EP) __Medicine & Health Sciences(MH)*
__Behavioral & Social Sciences(BE)* __Environmental Sciences(EV)* __Microbiology(MI)*
__Biochemistry(BI)* __Engineering (EN) __Physics and Astronomy(PH)
__Chemistry(CH)*
* __Mathematical Sciences(MA) __Plant Sciences(PS)
__Computer Sciences(CS)

*Denotes categories that usually involve experimentation with vertebrate animals and/or human subjects, and may use potentially
hazardous chemical or biological materials; as such, they require completed protocol forms before experimentation begins.

Hypothesis: (If the IV, then the DV because___)

If I change the type of Pepto-Bismol tablets dissolved, the original type will create the most
Bismuth because it shouldn't have any reason for the bismuth to be diluted.
 Materials Needed: (Chemicals? Procedure: Use the back or another sheet if necessary.
Equipment? Measurement tools?) 1.
-Pepto-Bismol Chewable Tablets(90)
-Pepto-Bismol Cherry Tablets(90)
-Pepto-Bismol Kids Tablets(90) 2.
-Blow Torch
-Clear Fireproof Flask
-Mortar and Pestle 3.
-Culinary Weight Measurer
-5% Hydrochloric Acid(

4.

5.

6.

7.

8.

First Bibliography Citation for background research : (No search engines such as Google)

Second Bibliography Citation for background research: (No search engines such as Google)

Teacher/Parent: Signature and approval required prior to the student conducting the experiment. If you are working with
humans, vertebrates, biological materials or hazardous substances, the experiment must be approved by administration
before you may begin. The approval sheets are available on the science expo website.

I acknowledge that I have read the above and attached information about my child’s project plan.

Student 1 Parent’s Signature: ________________________________________ Date: _____________

Student 2 Parent’s Signature: ________________________________________ Date: _____________

Student 3 Parent’s Signature: ________________________________________ Date: _____________