Younger Kansas Writers Entry Form

Type or print clearly.  Staple a separate form to each entry.  Duplicate forms as needed.If students fill out their own forms, teachers should proof for readability and accuracy.

Title of Work: ___________________________________________________________

Genre:    Poetry  _____       Prose ______      Illustration Included ______ (Black ink only)

Student’s Name: __________________________________________________________

Student’s Address: _________________________________________________                                                                           Street/Route                                         City                             ZIP

Student’s Year in School (circle one):  5        6         7         8        

Classroom Teacher's Name: __________________________________________

School Name, Address, & Phone:     
__________________________________________                                                              __________________________________________                                                            __________________________________________                                                            __________________________________________  

         STATEMENT OF AUTHENTICITY (Signatures must accompany each entry form)

THIS PIECE OF WRITING IS THE RESULT OF MY OWN ORIGINAL, CREATIVE EFFORTS.

Student Signature: ________________________________________________________

I verify that this manuscript submission is the original work of the student whose name it bears.

Sponsoring Teacher's Signature: _____________________________________________

The guidelines for submission of entries can be found on this web page.  Please read them carefully and follow them exactly. Submissions postmarked after the March 1 deadline cannot be considered.  

Send entries to the address provided on the "Submission Guidelines" page. 

Check KATE Membership:  ___ Individual     ___ Institutional    ___ KATE membership applied for