First Name *

Last Name *

Your Affiliation *
- Select Option GVSU Faculty or Staff Business/Industry/Organization

GVSU Faculty and Staff Department
- Select Option Annis Water Resources Institute Anthropology Department Art and Design Department Biology Department Biomedical Sciences Department Cell & Molecular Biology Deppartment Chemistry Department Classics Department College of Health Professions College of Liberal Arts and Sciences CLAS Dean's Office Geography & Planning Department Geology Department History Department Information Technology Mathematics Department Movement Science Department Pew Faculty Teaching and Learning Center Physical Therapy Department Physics Department Public Health Department School of Computing & Information Systems School of Engineering Sociology Department Statistics Department Writing Department Other Not listed Please specify a value for GVSU Faculty and Staff Department

Department *

Business/Industry/Organization *
- Select Option Amway Corporation GE Aviation Genzink Steel Grand Rapids City Engineers Grand Rapids Community College Harbor Industries Leppinks Pharmacy Merrill Lynch Newkirk Electric Shape Corporation Other Not listed Please specify a value for Business/Industry/Organization

Organization *

Address 1 *

Address 2

City *

State/Province *
- Select State Alabama Alaska American Samoa Arizona Arkansas Armed Forces Afr/Can/EU/ME Armed Forces Americas Armed Forces Pacific Baker Island California Colorado Connecticut Delaware Federated State of Micronesia Florida Georgia Guam Hawaii Howland Island Idaho Illinois Indiana Iowa Johnston Atoll Kansas Kentucky Kingman Reef Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Midway Islands Minnesota Mississippi Missouri Montana Navassa Island Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Palmyra Atoll Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Trust Territory of Pacific Utah Vermont Virgin Islands Virginia Wake Island Washington Washington D.C. West Virginia Wisconsin Wyoming

Zip/Postal *

Cell phone number *

Office Address *

Office Phone *

Email *

Please select the event you are willing to supervise from the Events list.

• Trial events are listed as Event Name - TRIAL B / C. 
• Arbitration and Scorekeeping are also in this list.

Which Event will you be supervising? *
- Select Option Air Trajectory B Air Trajectory C Anatomy & Physiology B Anatomy & Physiology C Astronomy C Bungee Drop C Chemistry Lab C Codebusters B Codebusters C Crime Busters B Disease Detectives B Disease Detectives C Dynamic Planet B Dynamic Planet C Ecology B Ecology C Electric Vehicle C Entomology B Entomology C Experimental Design B Experimental Design C Forensics C Fossils B Fossils C Geological Mapping C Helicopter B Helicopter C Materials Science C Meteorology B Metric Mastery B Microbe Mission B Microbe Mission C Mission Possible B Optics B Optics C Pentathlon - TRIAL B/C Potions & Poisons B Reach for the Stars B Road Scholar B Robot Tour C Scramber B Tower B Tower C Wind Power B Wind Power C Write it, Do it B Write it, Do it C Arbitration Scorekeeping Not listed Please specify a value for Which Event will you be supervising?

Which Event will you be supervising? *
- Select Option Aerial Scramble B Aerial Scramble C Air Trajectory B Air Trajectory C Anatomy & Physiology B Anatomy & Physiology C Astronomy C Cant Judge a Powder B Cant Judge a Powder C Chemistry Lab C CodeBuster B CodeBuster C Crime Busters B Detector Building C Disease Detectives B Disease Detectives C Dynamic Planet B Dynamic Planet C Ecology B Ecology C Experimental Design B Experimental Design C Fast Facts B Fermi Questions C Flight B Flight C Forensics C Forestry B Forestry C Fossils B Fossils C Geological Mapping C Meteorology B Microbe Mission B Microbe Mission C Optics B Optics C Reach for the Stars B Road Scholar B Robot Tour Track C Roller Coaster B Scrambler C Tower B/C Wheeled Vehicle Wind Power B Wind Power C Write It Do It B Write It Do It C Not listed Please specify a value for Which Event will you be supervising?

Are you the lead supervisor? (responsible for returning all forms) *
- Select Option Yes No

Are you working with a school team? *
- Select Option No Yes - 1 additional Yes - 2 additional Yes - 3 additional

First Name

Last Name

Email

First Name

Last Name

Email

First Name

Last Name

Email

Event Location Request: Please provide us any requests so we can do our best to provide an adequate space for the event.

Event Timing Request: Please provide us any requests so we can do our best to provide an adequate schedule. Example: morning preferred, self scheduled time blocks of 10 minutes per team, last year's timing, etc.

Additional comments