Writing Program Contest Entry Form

WRITING PROGRAM CONTEST ENTRY FORM

TO BE COMPLETED BY INSTRUCTOR

Course and Section No. ___________ Semester _________ Year ________

I nominate this student's work for the Writing Program Contest. I attest that it is representative of his/her work.

Instructor's Signature ___________________________________________

Description of assignment (or attach instructions):

_____ Student Submission _____ Instructor Submission

TO BE COMPLETED BY STUDENT

Full Name __________________________ Soc. Sec. No. _______________

Lexington or Campus Address _____________________________________
______________________________________________________________

Phone ________________

Permanent Mailing Address _______________________________________
_______________________ Zip Code ________ Phone ________________

I permit the submission of the accompanying writing assignment to the Writing Program Awards Competition. I understand that if the work is awarded a prize, it may be printed and distributed, as an illustration of effective writing. I also agree that the work may be copied for instructional purposes, without use of my name.

Signature ______________________________________________________