Key.aea1.k12.ia.us
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: January 20, 2020
*IMPORTANT… The following information MUST be filled out completely on each entry form!
*Local Reading Council: Eastern Iowa Reading Council Region –NE
*Short Story Chair (name): Nancy White
*E-mail address nwhite@ Best phone contact 319-929-3330 *Poetry Chair (name): Jana Sellers
*E-mail address jsellers@st-marys.pvt.k12.ia.us Best phone contact 563-920-5128
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