Application for Middle School History through Art Project
About the Student(s):
(Essayist/Essayist and Artist) Student Name ____________________Grade Level_____
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(Artist) Student Name _______________________Grade Level_____
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School District______________________ School Name ________________________
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School Address, City, Zip _________________________________________________
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______________________________________________________________________
School Telephone (
) Fax (
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Principal’s Name______________________________
Sponsoring Teacher
Name ___________________________________ E-mail _____________________
About the Submission:
Topic of Essay _______________________________
Art Medium _________________________________
Submission Release Form
Arts for a Complete Education/Florida Alliance for Arts Education, shall have the right to
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reproduce, exhibit, and otherwise use the submitted essay and artwork, in whole or in
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part, in any manner whatsoever in all media without limitations. A parent/guardian
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signature is necessary if the subject is under the age of eighteen.
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Essayist or Essayist/Artist Name (Please print): ________________________________
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Signature: _________________________________
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Date: _____________________________________
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Father/mother/legal guardian of the minor who signed this release:
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The release is entered into with my agreement and consent.
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Parent/Guardian Name (Please print): ________________________________________
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Signature: _________________________________
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Date: _____________________________________
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Address:___________________________________
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City: State: Zip:_____________________________
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Witness Signature: __________________________
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Date: _____________________________________
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Artist Name (Please print):_________________________________________________
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Signature: _________________________________
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Date: _____________________________________
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Father/mother/legal guardian of the minor who signed this release:
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The release is entered into with my agreement and consent.
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Parent/Guardian Name (Please print): ________________________________________
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Signature: _________________________________
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Date: _____________________________________
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Address: _________________________________
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City: State: Zip: ____________________________
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Witness Signature: __________________________
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Date: _____________________________________
This document must be witnessed and signed by guardian.
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All artwork submitted will become the property of ACE/FAAE.
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Please submit this application and release form with your 2-D art work and essay directly
to ACE/FAAE postmarked by
February 18, 2005
to the following address:
ACE/FAAE – History through Art Project
402 Office Plaza
Tallahassee, FL 32301-2757
Department of Education Contact:
June Hinckley, Music and Fine Arts Specialist
Phone: 850-245-0762
Suncom: 205-0762
E-mail: June.Hinckley@fldoe.org
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