AARP Eye Center
OFFICIAL ENTRY FORM
CSPERA - AARP 5TH GRADE GRANDPARENT ESSAY CONTEST
Colorado School and Public Employee Retirement Association
Student Name _________________________________________________________________
Teacher Name ________________________________________________________________
Teacher Phone Number__________________________________________________________
Teacher E-mail Address __________________________________________________________
School Name __________________________________________________________________
School Address ________________________________________________________________
School Phone Number ___________________________________________________________
School Principal’s Name _________________________________________________________
If known, the name of your local TV station, radio station, and/or local newspaper.
______________________________________________________________________________
DEADLINE FOR ALL ENTRIES TO REACH THE CSPERA OFFICE: March 24, 2017
ESSAY REQUIREMENTS
- 150 – 200 words in length, not including the title.
- Legibly written or electronically generated and printed in English. Use only one side of the paper. Additional sheets of paper may be used if necessary.
- Contains the components of a formal essay: i.e. introduction, supporting points and conclusion.
- Student name and school name written at the end of the essay.
- Entry form included with essay.
- Must be the original work of the student author, certified at the end of the essay by the following statement and signature:
“I certify that this is my original work.”
______________________________________
Student Signature
(OVER)
PARENT CONSENT FORM
MEDIA RELEASE
Student name ______________________________________
First Last
I hereby give permission for Colorado School and Public Employees Retirement Association (CSPERA) to release the use of my child’s name, photograph, and/or Grandparent Essay writing in publications such as those produced or sponsored by CSPERA, and mass media.
This Media Release shall remain in effect through the duration and presentation of the Grandparent Essay Contest, unless it is revoked in writing by me or another parent or legal guardian.
Printed name of Parent or Legal Guardian: _____________________________________
Signature of Parent or Legal Guardian: _________________________________________
Date: _________________________
Mail or e-mail entries, along with this completed form, to CSPERA via the addresses below.
Colorado School and Public Employee Retirement Association
1085 Peoria St., Aurora, CO 80011
Phone: 303.326.1808 or 1.800.748.2846 Email: CSPERA@aps.k12.co.us