Grade 4th 5th Age Birthdate

Student's Information:
Street address (line 1)
Street address (line 2)
Suite/Unit/Apt #
City State ZIP
Phone E-mail

School Program

School Information:
Street address (line 1)
Street address (line 2)
Suite/Unit/Room #
City State ZIP

Teacher/Contact person

Contact Information:
Work phone (no dashes) Fax (no dashes)
Home phone (no dashes)
E-mail

***In addition to submitting this form, please email your poetry entry as an attachment in Microsoft Word, Notepad, or PDF format to vapa2008@gmail.com no later than the April 1, 2008 deadline.

Please write "Ewald Poetry Entry and your school's name " in the SUBJECT line.

Include the following information in the BODY of the email:

Student's name
Student's school/program
Contact person's name

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