Calumet Regional Science Fair & Associated Art Exhibit
Prize Donation Form

Thank you so much for your support! The Calumet Regional Science Fair and Associated Art Exhibit can not encourage the students of Lake County without the support of the community. In order to properly acknowledge your gift, won't you please fill out the following form? If you would like the gift to be anonymous, we will be happy to comply with your wishes. We will have a page posted on the web, as well as signs and brochures at the Science Fair gratefully acknowledging our benefactors.

Name: _______________________________________

Address: _____________________________________

City, State, Zip: _________________________________

Company (if applicable): __________________________

Phone: _______________________________________

e-mail: _______________________________________

Prize Donation: ________________________________
Do you wish this prize to be for a science student, art student, or teacher? _____________________________

Category: _____________________________________

Do you wish to Judge the projects yourself, or send a special judge for the category, or would you prefer we judge the projects and assign the prize?

________________________________________________

If you wish for us to judge the projects and select the prize winner(s) are there any special criteria that you would like us to use in evaluating the students? (age, category, etc.)

_______________________________________________

Special Instructions: _____________________________

mail to: Calumet Regional Science Fair
              c/o Chemistry Department
              Indiana University Northwest
              3400 Broadway
              Gary, IN 46408

or fax to: (219) 980-6637