CalumetRegional Science Fair & Associated Art Exhibit
ScienceJudge Application

I would prefer to judge the following categories (Please list your 1st,2nd, & 3rd choice)

____	Behavioral & Social Sciences	____	Computer Science	____	Animal Sciences
____	Cellular and Molecular Biology	____	Earth Science	____	Biochemistry
____	Engineering: Materials & Bioengineering	____	Environmental Management	____	Chemistry
____	Engineering: Electrical & Mechanical	____	Mathematical Sciences	____	Microbiology
____	Energy & Transportation	____	Medicine & Health Sciences	____	Plant Sciences
____	Environmental Analysis	____	Physics & Astronomy	____	Teams

Name ___________________________________________________________________________

Firm or School ___________________________________________________________________

Title or Occupation ________________________________________________________________

Address _________________________________________________________________________

City _________________________________________ State ____________Zip _____________

E-Mail Address __________________________________________________________________

College Major(s) _________________________________________________________________

Minor(s) ________________________________________________________________________

This is my  _________ year to serve as a judge at the Calumet RegionalScience Fair & Associated Art Exhibit.

Signature _____________________________________________________________

If you are judging for a donated or special award, please write thename of the award here:

____________________________________________________________________________

If you are judging for a donate or special award, what type of listof students will you need to have to judge for your award?

_______________________________________________________________________________

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

or fax to: (219) 980-6673
or e-mail to lwoz@iun.edu
Application Deadline: February 15, 2007