(Please print or type all entries as you want information to appear on award plaques.)

DIVISION _________________________________________________________

CATEGORY _______________________________________________________

WRITER __________________________________________________________

NEWSPAPER ______________________________________________________

CITY _____________________________________________________________

DATE OF PUBLICATION _____________________________________________

TITLE OF ENTRY___________________________________________________

Check one: AM CYCLE: _______ PM CYCLE ________
 
 
 
 
 
 

Please include two copies of this form with each entry; one enclosed in the folder holding the entry, and a second form affixed to the outside of the folder. Thanks!