NASA SPACE SETTLEMENT DESIGN CONTEST ENTRY FORM

Please print this form after filling it and include it with your contest entry. If your entry is not associated with a school, enter your own adress, email and phone number instead.

NAME OF STUDENT(S)
GRADE AND AGE
NUMBER OF STUDENTS
NAME OF THE SUBMISSION OR PROJECT
TIME SPENT ON SUBMISSION
PARENT SIGNATURE FOR STUDENT NAME PLACEMENT ON WEB SITE AND USE OF ILLUSTRATIONS AND ARTISTIC RENDERINGS
TEACHER(S) NAME
TEACHER E-MAIL
NAME OF THE SCHOOL
ADDRESS OF THE SCHOOL	street street city state countryzip code
TELEPHONE NUMBER
DESCRIPTION OF CONTEST MATERIALS