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a Northern Illinois University partner

2016 International

Torrance Legacy

Creative Writing Awards

Application Form

Please type or print clearly

Authors Name: ________________________________________________________________________________
(Middle)
(Last)
(First)
Address: ____________________________________________________________________________________
(Street Address)

___________________________________________________________________________________________
(City)

(State)

(Zip/Postal Code)

Daytime Telephone Number: ___________________________________________________________________

E-Mail Address: ______________________________________________________________________________
Grade enrolled during Spring 2016: _______________________ Age at last birthday: ____________________
Please check the eligibility group level for which you are entering your submission:
_____ Group A: Ages 8-10

_____ Group C: Ages 13-15

_____ Group B: Ages 11-12

_____ Group D: Ages 16-18

School Name: _______________________________________________________________________________

School Address: _____________________________________________________________________________
(Street Address)

___________________________________________________________________________________________
(City)

(State)

(Zip/Postal Code)

Schools Telephone Number: ___________________________________________________________________

Teacher/Parent Name: ________________________________________________________________________
Teacher/Parent Signature: _____________________________________________________________________
Teacher/Parent Daytime Phone Number: _________________________________________________________
Teacher/Parent E-Mail: ________________________________________________________________________
Please select the genre for which you are entering your submission:
_____ Poetry _____ Short Story
Theme of Submission: ________________________________________________________________________
Title of Submission: __________________________________________________________________________
Number of Pages (including cover page) : ______________