Student's Name:  

Student's School:

Student's Phone:

School Phone#:

School Contact:
This may be a teacher or principal, or parent for home-schooled students

Student's Age:

Student's Home Address:

Student's Home Phone:

Student's E-mail:

Student's Social Security #:

Optional to provide at this time. However, contest winners will need to provide a valid social security number before cash awards are made.

A brief statement (two or three sentences) about how the cash award, if earned, will be used:

If you are submitting photos or a video, please provide a brief description (two or three sentences) about your entry. Skip this if you are entering a written essay.

By submitting this entry (written, photo, or video), you acknowledge that the North Central Regional Planning Commission (NCRPC) has the right to electronically publish the entry publicly, inmcluding the eyeonkansas web site, and to list you as the author.  You also are stating that the submission is an original work created by you. NCRPC also has the right to publicize your name in relation to the contest should your entry be selected for recognition. In addition, NCRPC has the right to publish your name in any publicity associated with the contest.