Tyner Prizes Student Submission Form

Student Name_____________________________________

Student Phone Number_______________________  Email address_________________

Complete Mailing Address____________________________________________________

Student ID____________________

Date work was written_________________________

Title of Work_______________________________________________________________

My signature certifies that the work submitted is my own original work, completed since January 1, 2011; that the work has been appropriately nominated by a member of the faculty; that the work is complete, meets nomination guidelines, and has been deemed suitable for publication; that I will edit the work as necessary prior to any publication (deadline 31 May 2012).

Signature___________________________

Date_______________________________

(If you are requesting that a professor consider your work for nomination, please attach this form to your work and give the packet to the professor. The professor will then need to fill out the Faculty Nomination Form.  Nominations must be submitted by March 16, 2012.)