ENTRY FORM/COVER SHEET

ROBERT BROME CREATIVE WRITING AWARD

Name: _______________________________________

Social Security Number:__________________________

Title of Submission: ______________________________________________________________________________

(In case of poetry, list an overall title and individual poem titles.)

I certify that my submission to the Robert Brome Creative Writing Award competition is my own (original) work.

___________________________________________________________

signature /date

Note: Your submission for the Brome Award will be printed in our literary magazine, Brome and Beyond, For that reason, please include both a wallet size senior picture and an "About the Author" statement with your submission.

Biographical Information (please complete):

Favorite authors-

Writing philosophy-

Inspiration for submitted manuscript-

Plans for next fall-