Poem Contest Submission Form 3rd-5th Grade

This form is designed for students to submit poems for the Digital 2021 CCEW Illustrated Poem Contest. The deadline to submit entries is Sunday, April 25, 2020 at 11:59 PM Eastern.

Entries must be submitted to the correct local contest in order to be valid. INVALID ENTRIES WILL BE DISQUALIFIED. You must look up your correct ACS local section name using your ZIP code via the lookup platform at www.ccewlookup.acs.org. If your ZIP code falls in an undesignated area, please find your nearest ACS local section by searching by state.

Your Local Section Contest * 🛈

Student First Name *

Student Last Name *

Student Grade *

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Email *

Parent/Guardian Street Address *

Parent/Guardian City *

Parent/Guardian State *

Parent/Guardian ZIP *

School or Sponsoring Group Info

Poems must be submitted through a valid school or sponsoring group (e.g., your local Homeschool Association, Boys and Girls Club, Scout Troop, 4-H, etc.).

School or Sponsoring Group Name *

School or Group Contact First Name *

School or Group Contact Last Name *

School or Group Contact Email *

School or Group Street Address *

School or Group City *

School or Group State *

School or Group ZIP *

Poem Upload and Release Agreement

Poems must be submitted as a High-Resolution JPEG, PNG, or PDF. DO NOT compress or reduce the resolution of the original image.

Upload your poem here: *

Was your drawing created digitally using an app or illustration software? *

Yes

No

What app or illustration software did you use? *

I hereby grant to the American Chemical Society, its affiliates and licensees (collectively referred to as the "Society"), royalty-free permission, including the exclusive worldwide, irrevocable rights in all languages, to reproduce in all formats, including, but not limited to print, microfilm, electronic, and/or CD-ROM, the image submitted.

Further, I hereby waive my right to inspect or approve any copy that is used in connection with the image and release and discharge the Society from any and all claims arising out of use by the Society of the image for the purposes described above. *

I have read the foregoing and fully understand its contents.