Release Form for Students' Writing


     This form confirms that I have the right and do release the accompanying writing selection for publication on the WWW. I also confirm that the writing was done by the student without substantial assistance from an adult. I understand that the writer's name, grade level, age, city, and state (and/or country) will be indicated as the source of the writing and that the writing will be edited to conform to the norms of standard English. I also understand that submission does not necessarily mean that the writing will be used.

Name of Writer:_______________________________________________

Street Address:____________________________________________________
                                     (For correspondence purposes only)

City:____________________________ State/Country:_____________________

e-mail address:____________________________________________________
                                     (For correspondence purposes only)

Title of Writing:____________________________________________________

Age of Writer:________     Grade Level of Writer:__________
                               (Both of the above should be at the time of writing.)

Writer's Name:____________________________________________________

Signature:___________________________________ Date:_________________

Name of Parent/Legal Guardian:________________________________________

Signature:___________________________________ Date:_________________

Send to: Dr. Ed Vavra, DIF #112, Pennsylvania College of Technology, 
One College Ave. Williamsport, PA 17701