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Chemists Celebrate Earth Day (CCED) 2015
“Climate Science—More Than Just A Weather Report!”
ILLUSTRATED POEM CONTEST ENTRY FORM
Please fill out this form, print, and attach to the back of the poems. All fields are required.
Incomplete forms will invalidate the entry.
The receipt deadline for the Central New York Local Section Contest is Friday, April 3, 2015.
Student’s Name:
Grade:
Parent/Guardian Email:
Parent/Guardian:
School Name or sponsoring group:
(e.g. Boys and Girls Club or Scout Troop, 4-H, etc.)
Teacher’s Email:
Teacher’s Name:
School Address:
Address Line 2:
City:
State:
Judging Category (Check one)
K-2nd
3rd -5th
6th – 8th
Zip:
9th – 12th
FOR LOCAL SECTION USE ONLY
Local Section Name (Number): Central New York L112
CCED Coordinator Name:
Sally Mitchell
Email / Phone:
sbmitchell2@gmail.com 315-637-9837