2010 "Save Me a Spot in College" Contest

STUDENT ENTRY Form

Answer the contest question:  "Why should California leaders save you and your peers a spot in college?"

Categories:  Written Word, Poster, TV Ad

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• Do not fill out this form until you have completed your entry(s) and read the instructions.
• Remember to print a copy of this form BEFORE you click "submit".
• If you are 12 and younger as of March 15, 2010 you need to have a parent or legal guardian sign a copy of your Entry Form and then mail it (even if you are entering your written word entry online)

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*indicates a required field

Key Information About You:

First Name*                      Last Name*

 

Birthdate* (for example: 01/02/1994 - you must use slashes)

Grade* (for example: "9" for ninth grade)

Name of School* (for example:  "Winn Middle School")

Is this a:* (High School, Middle School, or Elementary School)

HighSchoolMiddleSchoolElementarySchool

Are you a part of any of the following programs?

 AVID    ¦     GearUP    ¦     K-16 Bridge ProgramBridgeProgram

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How to Contact You:

Email Address* (you will receive a confirmation at this address)

Please confirm your Email Address*

YOUR Home Address

Street Addr.:*

Addr. line 2:*  

City*                                   State*       Zip*

       

County* (NOT COUNTRY)    Address Type*

       home addressteacher addressschool addressother   

Phone #* (ie: 808-555-1212)        Phone Type*

       homepersonal-cellparents-cellteachers-phoneother

Alternate Phone #                 Phone Type

       homepersonal-cellparents-cellteachers-phoneother

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How You Heard About the Contest:

How did you hear about the contest?*

friend or familyteacher or counselor at your schoolcollege eventother

If you answered "other" please tell us the name of that program or organization:
(for example: Boys & Girls Club, Upward Bound, Cal-SOAP, College Options, etc.)

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Info About Your Entry:

What category(s) are you entering (check all that apply)

Written Word

I am copying and pasting it below

I am sending my written word entry by mail

Poster

TVad

 I am entering a TV Ad by myself 

I am entering a TV Ad as a group of up four students

     If entering a TV Ad as a group, list the first and last names of all other members in your group, besides yourself:

(only up to 3 others allowed)

1.

2.

3.

(ALL group members must fill out and submit their own Entry Form)

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Terms:

Please read the Terms of Agreement and then initial here to verify that you have read them (for example: LR for Liz Robles):*

 

Are you 12 and younger?  If so, once you print out this form - you need to have your parent or legal guardian sign here:

__________________________ << SIGN HERE to give your son/daughter permission to enter the contest

__________________________ << PRINT YOUR NAME here

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Copy and Paste Your Written Word Entry Here

If you are submitting a written word entry, we prefer that you copy and paste it here.  Then you don't have to mail it in!

 

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Print a Copy of this Entry Form!

Print a copy of your Entry Form before you submit it. You must print a copy if you are mailing in an entry and if you are 12 years old and younger. Entries that do not have an Entry Form attached to them will be immediately disqualified. To print, go to "File" (located on the toolbar towards the top of your browser) and then go to "Print".

Click the Submit Button!

By clicking the "Submit" you are agreeing with the TERMS OF AGREEMENT and that the work you are submitting is your original work, not copied or published by another other individual or entity.

• Questions?
  
  Please direct any questions you may have about the "Save Me a Spot in College" scholarship contest to:
  
  contest@collegecampaign.org
  
  or
  
  1-800-459-9586.