The National Writing Board
                            Form to Accompany Essays


	Your name, gender, grade, school, region, etc. will not be known to those 
	who rate your paper. They will only have the paper, its length, and code 
	number when they judge the work.  Each paper must be accompanied by a check 
	for $200 (US), made out to the National Writing Board, and a notarized copy 
	of this form. Send three (3) printed copies of your paper, with only the 
	title and length in words showing on the first page. DO NOT INCLUDE ANY 
	INFORMATION ON THE PAPER OTHER THAN THE INFORMATION REQUESTED.  Send essays,
	the form, and fee to:
	
	The National Writing Board
	730 Boston Post Road, Suite 24 
	Sudbury, MA 01776 USA  
	(800) 331-5007 
	Email: fitzhugh@tcr.org 
	
	                           THIS FORM MUST BE NOTARIZED
	
	
	Paper Title:______________________________________________________________________ 

	Paper Length: _____________ words

	Name of Author:___________________________________________________________________

	Current Grade (check one):    Freshman_____ Sophomore_____ Junior_____ Senior_____

	Author's Email Address: __________________________________________________________

	Home Address: ____________________________________________________________________   

	______________________________  City: ____________________ State: ____ Zip: ______

	Year of High School Graduation: _________________ Home Phone: (____) ____ - ______ 

	Name of Teacher:__________________________________________________________________ 

	Title of Course (if any): ________________________________________________________   

	Name of School: __________________________________________________________________   

	School Address: __________________________________________________________________  

	______________________________  City: ____________________ State: ____ Zip: ______   

	School Phone: (____) ____ - ______ 

	Name of Principal: _______________________________________________________________

	School Email Address: ____________________________________________________________



	AFFIRMATION: By signing this form, and having it notarized, I affirm that the paper 
	I am submitting for evaluation by the National Writing Board is my own academic work. 
	I understand that plagiarism is theft, and a dishonest attempt to gain unearned 
	advantage in the assessment process, and can bring serious consequences to me. I also
	understand the National Writing Board will conduct checks of the authenticity of 
	student work.


	Author's Signature: ______________________________________________________________


	Teacher Signature: _______________________________________________________________


	Notary Public: ___________________________________________________________________


	Date (mm/dd/yy): ____/____/______