V&P Literary Group/Johnny CAN Read and Write Program

Johnny CAN Read and Write Award
Application

Please fill in all relevant Information and print this page.

* All Fields Are Required

First Name:

Last Name:

Male:

Female:

Grade

Age::

Address:

State:

City:

Zip:

Home Phone:

Email:

Parent/Guardian:

School Name:

School Phone:

Genre:

Date:

Briefly, tell us something about youself:

Mail application form with one page synopsis, parental consent form and $50
non-refundable entry fee, made payable to Vision & Purpose Literary Group,
c/o Johnny CAN Read & Write Award Program, Parkway Plaza Executive Suites,
Willingboro Town Center, 200 Campbell Drive, Suite 245, Willingboro, NJ 08046,
(609) 526-5059. Please see our Sponsorship Letter for assistance with the cost
of your entry fee.

Back

                                              Parental Consent

I,_______________________ authorize my child _______________________ to participate in the

Johnny CAN Read and Write Award Program 2011.

______________________         __________
  Parent/Guardian                         Date

Johnny CAN Read and Write Award Program, c/o V&P Literary Group, Parkway Plaza
Executive Suites, Willingboro Town Center, 200 Campbell Drive, Suite 245, Willingboro,
NJ 08046, Attn: JCRWA, (609) 526-5059

Office Use Only

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