(Print form and submit with essay)

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


PARENTS/GUARDIAN NAME____________________________________________




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)________________________

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.


Parent/Guardian Signature