Project Children L.E.A.D.

- Point Park University

Diversity Creativity Contest: Official Entry Form
Please attach this form to each student’s entry. All entries must be received by March 26th.


Student Last Name First Name Age Grade

Address City State Zip Code

School Phone Number E-mail Address

Check One: Short Story Poem Artwork

TO BE COMPLETED BY STUDENT’S PARENT OR LEGAL GUARDIAN

Parent/Guardian’s Last Name First Name

Address (if different from above) City State Zip Code

Daytime Phone Evening Phone E-mail

TO BE COMPLETED BY STUDENT’S TEACHER

Teacher’s Last Name First Name Grade Phone Number E-mail

School Name School Address School Phone Number

We certify that the information on this entry form is true to the best of our knowledge, and that the
student’s submission is an original work. We understand that all entries become the property of Project
Children L.E.A.D. and that they may be put on display or used for promotional purposes on the Project Children
L.E.A.D. website. Entries may not be returned.

Parent/Guardian Signature Date Teacher Signature Date

Please mail all entries to

Dr. Vincenne Revilla Beltran, Director
Point Park University -Education Department
Project Children LEAD “Diversity Creativity Contest”
201 Wood Street
Pittsburgh, PA 15222