SCBWI-MICHIGAN 2002 MENTORSHIP PROGRAM ENTRY:
(Please print neatly or type)

Name: ________________________________________________________________

Address: ______________________________________________________________

City: ____________________________________________, MI     Zip:_____________

Phone: (daytime) _______________________ (evening) __________________________

E-mail: ________________________________________________________________

Manuscript Title: _________________________________________________________

STATEMENT OF ELIGIBILITY
I certify that I am a current member of SCBWI and reside in Michigan. I am an unpublished children's writer (ie, an associate SCBWI member in the writing category) as defined above. I have never received monetary payment or compensation for, or self-published, any written work published in a book, magazine, anthology, or electronic media where the intended audience or consumers are children.

I certify that all writing is of my own creation. I understand that it is my responsibility to meet all submission deadlines and criteria and that noncompliance with any deadline or submission criteria results in my disqualification. I understand that judging is a subjective process and that all decisions are final.

_____________________________________________    ______________
Signature                                                                                Date

I have signed and dated the above Statement of Eligibility and included it along with the following as my entry:

___ Complete submission: one cover sheet plus three copies each of Goal Statement and Manuscript.
___ Self-addressed stamped post card (for confirmation of submission receipt).
___ $15 payment enclosed with my event registration.

--this form was printed from www.kidsbooklink.org--