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CREATIVE WRITING ENTRY FORM 2019-2020
POETRY/ SHORT STORY (Circle one)
PLEASE TYPE OR PRINT LEGIBLY IN BLUE OR BLACK INK
Attach one of these forms as the last page of each entry submitted to local and/or state contests
If entering as a co-author please include a page for each author, stapled together.
Story/Poem Title: __________________________________________________________________________
Grade: ______________________ *Word Count (Short Story) ________________
STUDENT: first and last name_____________________________________________________________
Student’s address: ________________________________________________________________________
Street City Zip
PARENT(s): first and last name ____________________________________________________________
Best contact phone number: ______________________________________
Best contact e-mail address: ________________________________________________________________
TEACHER: first and last name: ____________________________________________________________
Teacher’s e-mail address: __________________________________________________________________
Teacher’s best contact phone number: ______________________________
SCHOOL: _________________________________________________________________________
School Address: __________________________________________________________________________
Street City Zip
NEW! LOCAL COUNCIL DEADLINE: Postmarked by_February 1, 2019
*IMPORTANT… The following information MUST be filled out completely on each entry form!
*Local Reading Council: _State Only______________________Region – SO (please circle one)
*Short Story Chair (name): __Barbara Carroll___________________________________________
*E-mail address ___bgcarroll1@_____________Best phone contact__708-805-5550____
*Poetry Chair (name): _____ Barbara Carroll____________________________________________
*E-mail address ___bgcarroll1@_____________Best phone contact__708-805-5550____
Mail entries to: Barbara Carroll
150 Greenwood
Burlington, Iowa 52601
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