Student and Organization Information

Student Name:

Student Grade:

Parent/Guardian Name:

Parent/Guardian Email:

Parent/Guardian Address:

Parent/Guardian City:

State:

Zip:

School or Sponsoring Group (e.g. Boys and Girls Club or Scout Troop, 4-H, etc.):

Teacher Name:

Teacher Email:

School Address:

School Address 2:

School City:

State:

Zip:

Please send any follow up for the student to the parent  or school  address.

Illustration Type (Check one)

Hand-drawn art _______ Digitally created art ____________

If the poem was digitally created, please name the software used below:

 ____________________________________________

Judging Category by Grade (Check one)

K-2. 3-5 6-8. 9-12

FOR LOCAL SECTION USE ONLY

Local Section Name:

NCW Coordinator Name:

NCW Coordinator Email/Phone: