ENTRY FORM
Title of essay: ___________________________________________________
Author's name:___________________________________________________
Address:_________________________________________________________
Telephone number(s):___________________________________________
Email Address___________________________________________________
For submission as a (select one):
__ short essay (4-10 pages) ___ long essay (8-20 pages)
Course for which the essay was written: ______________________
Semester in which course was taken (circle one):
Spring 2006; Spring 2 2006; Summer 1, 2006; Summer 2, 2006; Fall 2006; Spring 2007
Instructor: _____________________________________
I hereby confirm that this essay was originally accepted for partial fulfillment of the requirements for credit in my course
[title, number and section] ______________________________________
and is, in my judgment, the student's original work.
Instructor's signature: _____________________________________
I hereby affirm that the essay I have submitted is original and represents my own work.
Student's signature:________________________________________