Student Name

Age

Grade

Email Address

Home/Cell Number

Home Address

City

State: NJ

Zip

School's Name

Art Teacher's Name

Title of Submission

Medium (if artwork)

Size (height x width, if artwork)

Estimated Value (if artwork)

Are you willing to sell this art piece?       YES      NO     (If yes, what is your asking price?)

Approximately how long did it take you to complete?

I understand, agree and give permission to Friends of Teen Arts, Inc. (FOTA) to display and/or reproduce my work in any or all of its publications and outreach efforts including but not limited to the Touring Art Exhibit, Calendar and Anthology.

Student Signature

Adult's Signature (if student is under 18)

What inspired your work? (Your reason for doing it) Please attach additional page if needed for the following questions.

Career Aspirations & Goals:

Graduating Seniors: What are your plans for September? If you will be attending college, which one?