APPLICATION/AFFIDAVIT: NFSPS COLLEGE/UNIVERSITY POETRY COMPETITION

NAME

TITLE OF MANUSCRIPT

CURRENT COLLEGE/UNIVERSITY

SCHOOL LOCATION (CITY/STATE)

MAJOR  AND MINOR (STUDIES)

STATUS (FRESHMAN, SOPHOMORE, JUNIOR, OR SENIOR)

  

CAMPUS ADDRESS

CITY, STATE, AND ZIP CODE

HOME ADDRESS

CITY, STATE, AND ZIP CODE

YOUR EMAIL ADDRESS

10 DIGIT HOME AND CELL/ALT PHONE NUMBERS (AFTER THE NUMBER DESIGNATE H FOR HOME, C FOR CELL, OR A FOR ALTERNATE)

NEAREST STATE POETRY SOCIETY (SEE LINKS AT http://www.nfsps.com/links.htm)

 

 

Your writing goals (Please use the back of this page or another sheet of paper if submitting hard-copy manuscript. Please limit to 300 words).

 

 

AFFIDAVIT

Sign the statement below in the presence of a notary public, who should also sign as witness and stamp this form with his or her official seal. A notary public is an individual authorized to serve as an official witness for the signing of documents. They often can be found at a bank, local court house, or a law, accounting, or insurance firm--or check your local phone directory.

 

I certify under oath that the above information is accurate and complete and that the manuscript I am submitting is my own original work.

Signed: ______________________________________________________ Date: ____________________

Subscribed and sworn before me this __________day of _____________________, 20____

Signed: ______________________________________________________

 

NOTARY SEAL: