DISCOVER What Art is...


ENTRY FORM

Please photocopy this entry form as necessary for participation. Remember to keep a copy of the completed application for your records. Please fill out this form completely and send it with each art submission that you mail to the participating VSA arts affiliate located in your state.


PARTICIPANT INFORMATION:

ARTIST’S NAME: _______________________________________________ 

DATE OF BIRTH: _____/_____/__________

PARENT/ GUARDIAN: _______________________________________________

ADDRESS: ________________________________________________________

CITY: ______________________________________ 

STATE: ________________ 

ZIP: ________________________

PHONE (DAY): _________________________________ 

E-MAIL: __________________________________________

DISABILITY (IES): _______________________________________________

NAME OF ART TEACHER (IF APPLICABLE) _________________________________________________________________

SCHOOL ADDRESS: _________________________________________________

CITY: ______________________________________ 

STATE: ________________ 

ZIP: ________________________


ARTWORK SUBMISSION:

TITLE: __________________________________________________________

HEIGHT: _________________________ 

WIDTH: ________________________ 

DEPTH: _________________________

MEDIA: __________________________________________________________

YEAR CREATED: ___________________________________________________

DESCRIBE THE ACTIVITY PRESENTED IN THE CALL THAT INSPIRED YOUR ARTWORK AND/OR HOW THE PIECE RELATES TO THE THEME:
_________________________________________________________________

_________________________________________________________________

NOTE: YOUR NAME, ADDRESS, AND PHONE NUMBER SHOULD BE PENCILED ON THE BACK OF YOUR ART SUBMISSION FOR IDENTIFICATION PURPOSES.

I hereby declare that I am producer of the artwork and that the artwork is original. By signing this agreement, I agree to allow VSA arts to photograph and/or publish my artwork, as well as use my submission and biographical information for public relations purposes, including broadcast, print, and electronic media.

Artist’s signature: ______________________________________________

Parent/ Guardian signature: ______________________________________