ALLIANCE FOR YOUNG ARTISTS & WRITERS

Grade: 11
REGION: NY001W SCIENCE FICTION & FANTASY
New York City Writing
Region 12/02/2019
03:59:13 ET
2020 SUBMISSION FORM
STUDENT INFORMATION INSTRUCTIONS

Thomas Frix Submit this form to:

6810 Bay Cliff Terrace, Brooklyn, NY 11220 ALL SUBMISSION FORMS MUST BE DIGITALLY UPLOADED by 11:59 pm ET
Age: 16 Grade: 11 on December 3. Printed submission forms will not be accepted.
Email: Thomas.Frix@writopialab.org
Parent/Guardian email: Alida.Frix@gmail.com Deadline: 12/03/2019
Home School Submission Fee: $7.00
Amy Dupcak Remland (amyr@writopialab.org) Additional Details:
Janelle Williams (Janelle@writopialab.org) ALL INDIVIDUAL PAYMENTS MUST BE DIGITALLY SUBMITTED via PayPal
by 11:59 pm ET on December 3. Only schools submitting payment for
One of your educators must sign this form. multiple students may submit a check. A list of the covered students must
be included. All payments must be RECEIVED by December 3.
WORK SOURCES

My own observations, ideas, and imagination

A God For Worms

Science Fiction & Fantasy
Barcode: 13466477

NOTE: Registration for this work is incomplete (as of 12/02/2019 03:59:13 ET)
You may still sign and submit this form, but please remember to complete the registration before the deadline!

TERMS & CONDITIONS

I affirm that all information entered through the Online Registration System (ORS) is true and accurate. I understand the following: the information I provided may not be changed or
corrected after my registration deadline has closed; I grant permission to the Alliance and its Affiliate Partners to publish, in all print and electronic media, the student's name, age,
grade, school, and educator information; the Alliance and its Affiliate Partners may release information entered through the ORS to colleges and universities interested in
recognizing and supporting students who have submitted to the Scholastic Awards, as well as for consideration for additional scholarship and recognition opportunities; works
receiving national awards will be held for up to two years. I further agree and acknowledge that the Alliance has the authority, in its sole discretion, to revoke any awards issued by
the Alliance in the event the Alliance determines that a submission does not meet the requirements of the Participation Terms or other Alliance policies; the Alliance assumes no
responsibility for lost or damaged work; if any element of the submission requires rights releases, all rights and permissions have been obtained, as required by law.
I have read, fully understand, and agree to all requirements for participating in the Scholastic Art & Writing Awards as outlined above, in the guidelines, and in the Participation
Terms (including the Copyrights Release, Copyright & Plagiarism, and Terms of Artwork Return policies).

Student Signature:
Thomas Frix Date
Educator Signature:
Date
Parent / Guardian Signature:
Alida Frix Date