Please fill out this form and print two paper copies. Attach one to your contest entry and include the other but leave it unattached. If this form is not working properly, you can fill out the old form here.

Student Information

You must have a parent sign in the "Parent Signature" box after printing to give NASA permission to place the student's name on NASA's web site and to use any part of the entry for any purpose.

Parent Signature
Student #1 First Name
Last Name
Grade

Project Information

Tell us about your project.

Name of Your Project

Time Spent on Project

Description of Project Materials (especially if there is more than one part)

Contact Information

Where should we send the certificates to? If you are working under the guidance of a teacher, include your teacher's name.

Telephone Number

Name to Send Certificates To

Address

Teacher Names (optional)

Email

Name of School (optional)

Thank you for participating in this year's Space Settlement Design Contest!