Contest Form 98

Contest Form 98

Contest Entry Form Braille Readers Are

Leaders Contest November 1, 1997, to February 1, 1998 Mail entry form after

February 1, 1998 to:

Braille Readers Are Leaders contest,

1800 Johnson Street,

Baltimore, Maryland 21230

Grand total of pages read___________

Student's Name:__________________________________________________

Birthdate:_______________Age:_________Grade:_______________

Address:_________________________________________________________

City:_________________________State:_________zip:____________________

Parent's Name:___________________Phone

H:_____________W:___________

School Name:_______________________________________________________

Address:_________________________________________________________

City:______________________State:_________Zip:_____________

Phone:__________________________________________

Certifying Authority: Name:____________________________________

Position: Parent [ ] Teacher [ ] Librarian

[ ] Address:_______________________________________________________ City:_______________________State:____________Zip:______________

Phone H:_______________W:_____________________ YES [ ] NO [ ] Did you enter

last year's contest (1996-97)? YES [ ] NO [ ] Is this the first time you have

ever entered this contest?

Category: (Check one)

[ ] Beginning Print-to-Braille (This

category is for former or current print readers who began to learn and use Braille

within the past two years. Children who began Braille instruction in Kindergarten

or First Grade are not eligible for this category.)

[ ] Kindergarten and First Grade

[ ] Second through Fourth Grades

[ ] Fifth through Eighth Grades

[ ] Ninth through Twelfth Grades

One of the prizes for the contest is

a special T-shirt. If you should be a winner, what size would you require? (Check

one)

Children's: S (6-8); _______ M (10-12);_______

L (14-16)_________

Adult: S (34-36);______ M (38-40);______L

(42-44);_______ XL_______

1998 BRAILLE READERS ARE LEADERS CONTEST

Book title/Magazine article (Mag. Pub.

Date) # of Pages

Total # of pages______________________

To the best of my knowledge this student

did read these Braille pages between the dates of November 1, 1997, and February

1, 1998.

______________________________________

_______________

Signature of Certifying Authority Date