| *First Name: |
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| *Last Name: |
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| *Street: |
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| Street 2: |
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| *City: |
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| *State: |
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| *Postal Code: |
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| *Email: |
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| *Phone: |
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| *School: |
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| *Responsible Family Member in Your Household: |
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Example (mom, dad, grandma, grandpa, sibling (over 18), guardian, aunt, uncle, etc. -- this is someone who will vouch for the original creation of your work) |
| *Responsible Family Member Phone: |
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| Permission: |
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Checking this box gives Lighthouse Learning Community, Inc permission to use your work in future publications (online, media, and in print). |
| *Assurance of original creation: |
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Checking this box means that your work has been created by you and any other influential or cited work has been given proper credit. |
| *Age: |
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| *Assurance of age: |
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Checking this box means that you are a student in grades K-12 during the 2009-2010 school year. |
| *How did you hear about this project? |
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Examples (website, through school - teacher, through school - administrator, friend, other(describe)) |
| *Who or what influences you and your thinking the most? |
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| Upload a picture of yourself here: |
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Upload your file here
File Types:- Written Documents: Microsoft Word (.doc, .docx); Rich Text Format (.rtf); or Plain Text (.txt)
- Audio Files: .mp3, .wav
- Video Files: .mpg, .mov, .wmv, .avi, .mp4
- Visual Files/Pictures: .jpg, .tiff, .png, .gif
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| *Upload your main submission here: |
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* denotes required field |
