Young Authors Project 2015

2016

Intent to Participate
Due: October 30, 2015

Council Name:
__________________________________________________________________
Young Authors Chairperson:
________________________________________________________
YA Chairpersons Email address:
____________________________________________________
YA Chairpersons Mailing address:
__________________________________________________
__________________________________________________________________
________________________
YA Chairpersons Phone number:
___________________________________________________
Presidents name:
__________________________________________________________________
___
Presidents email address:
___________________________________________________________
Presidents mailing address:
________________________________________________________
__________________________________________________________________
________________________
Presidents phone number:
__________________________________________________________
Mail completed form to:
Sabrina Secrest

2930 C Valley Court

Winston-Salem, NC
27106

Young Authors Entry Form 2015-2016

All entries must be sent to the North Carolina Reading Council
through your local reading council. Visit NCReading.org to identify
your local council. Entries sent from individuals will not be
considered for this project. Every single blank on this form must be
filled in completely and clearly. Please use only this form. Do not
use a form from another year or make up your own form. There is no
optional information.
*** Any entry without a completed entry form will be disqualified
from judging.
Please tape this form to the BACK of each entry. No staples please!

Please print clearly in dark ink.

Grade Level of Entry: K 1 2 3 4 5 6 7
8
Forever Young
(Circle appropriate level)

9 10 11 12

Title of entry:
_____________________________________________________________________________________
______
Authors name:
_____________________________________________________________________________________
____
Authors home address:
________________________________________________________________________________
_____________________________________________________________________________________
_______________________

Authors email address:

_________________________________________________________________________________
Authors home phone with area code:
__________________________________________________________________
Complete name of authors school:
______________________________________________________________________
Teachers name: ___________________________________ Teachers email:
____________________________________
Name of the local NCRA Council:
_________________________________________________________________________
Young Authors Chairperson:
______________________________________________________________________________

Permission to Publish: I verify that my entry is my own work and has not
been plagiarized. If the Young Authors Committee selects my entry, it will be
published in the state book. I understand that all money from the sale of this
book will be used for the Young Authors Project.
Authors Signature:
________________________________________________________________Date_________
___
(All authors, regardless of age must sign this form to be eligible for judging.)
Parents Signature:
______________________________________________________________Date___________
__
Anyone under the age of 18 must also provide a parents signature.):
Please do not write in the spaces below. These spaces will be used for state judging.

Judge #1
Score__________
Initials____________

Judge #2
Score__________
Initials____________

Judge #3
Score__________
Initials____________

State judging will involve 2 judges. A third judge will be consulted if there is a greater than
2-point discrepancy between the first two judges.