(Print form and submit with essay)

La Plaza Computer Essay Contest - Entry Form
(Read contest information and requirements before filling out form) 

NAME_________________________________________GRADE_______________

PARENTS/GUARDIAN NAME____________________________________________

ADDRESS______________________________________PHONE_______________

      ______________________________________

SCHOOL_______________________________________

Do you presently have a computer in your home?_____Yes_____No

Do you presently have an email account?_____Yes_____No.

If yes, with who? (i.e., La Plaza, Hotmail)________________________

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I certify and agree to the following:

I understand and agree to comply with all contest regulations. I am not related to any La Plaza Staff and/or Board members. I give permission for La Plaza Telecommunity to take pictures and document comments from me for placement on La Plaza's Web Site and for submission to other media organizations.

______________________________________________Date__________________
Signature

_____________________________________________Date___________________
Parent/Guardian Signature