Entry Form

(Electronic Copies available at www.ctstateu.edu and www.ctyoungwriters.org

This form is double-sided.

(Please Print or Type)

Student Name ___________________________________________

Complete Address__________________________________________

City__________________________ State_________________________ Zip Code________________

      e-mail address ________________________________________________

      Phone Number ___________________________________________

Date of Birth ______________________Age______________________

Nominating Teacher________________________________________

(print full name)

School _____________________________________________________

Complete Address__________________________________________

City__________________________ State______________________________ Zip Code_____________

e-mail address _________________________________________________

County ____________________________________________________

School Phone Number______________________________________

Teacher Signature (required) ________________________________

Submission Category (circle one): PROSE POETRY

Title ______________________________________________________

Number of Pages ___________________________________________

Submit 4 copies of your entry together with this entry form. Submission must be postmarked by February 1, 2007 and accompanied by this entry form. Mail to IMPAC—CSU Young Writers Awards, Connecticut State University System,

39 Woodland Street, Hartford, CT 06105-2337. IMPAC-CSU Young Writers Trust maintains first rights for the written works. Reprint permission may be granted.

Errors on entry form, e.g., wrong county, could result in disqualification.

See reverse side or page 2 for complete entry rules.

Entry Rules

A teacher in a public or private school must nominate entries for the competition. Home school nominations are also accepted.

Young writers between the ages of 13 and 18 years of age should submit four copies (1 original and 3 copies) of their best single work in poetry or prose; only one entry per student is permitted. Prose entries may include essays, short stories, reviews, plays, research papers or news articles. There are no length requirements.

Entries should be typed, double-spaced, on 8½ by 11-inch paper and submitted along with this entry form. Please number each page of your submission. Do not place your name on your work of prose or poetry. Your entry will be confidential when distributed to judges.

Errors on entry form, e.g., wrong county, could result in disqualification.

The entries must be postmarked by February 1, 2007 and submitted to:

IMPAC—CSU Young Writers Awards

Connecticut State University System

39 Woodland Street

Hartford, CT 06105-2337

Checklist:

Entry:

___ 8½ x 11 paper

___ 4 copies (one original & 3 copies)

___ typed

___ double-spaced

___ name of author should not appear on the submission

___ pages numbered

Entry Form:

___ Print (legibly) or type (except for teacher signature)

___ County (not country)

___ Age of student: 13, 14, 15, 16, 17 or 18 during school year 2006-2007

___ Teacher signature required

___ Category circled

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