Title of the
of School or Organization:
Name of School or Organization:
you a new or returning coach? (Check one)
many teams did you form, including those who didn't submit an
many students participated (not just completed entries)?
did you find out about the competition? (Check one)
someone recommended the competition to you, who recommended it?
Federal agencies may not conduct or sponsor
a collection of information unless the collection of information
displays a currently-valid OMB control number and informs
potential persons who are to respond to the collection of
information that they are not required to respond to the
collection of information unless it displays a currently-valid
OMB control number. The OMB control number for this collection
is 3145-0023. Public reporting burden for this collection
of information is estimated to average 12 hours per response,
including time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed,
and completing and reviewing the collection of information.
Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions
for reducing this burden, to Judi Shellenberger, Executive
Director, Christopher Columbus Fellowship Foundation, 110
Genesee Street, Suite 390, Auburn, NY 13021; and to the Office
of Information and Regulatory Affairs, Office of Management
and Budget, Washington, DC 20503.
We affirm that this entry for the Christopher
Columbus Awards is original and has been independently developed
by the student members of the team. We verify that all members
are currently enrolled in sixth, seventh, or eighth grade
and that our coach is 18 years or older. We further affirm
that we have read and understand the rules of the competition.
We understand that if our team is selected as a finalist,
we will attend the Columbus Academy at Walt Disney World® in
June 2014. Signatures verify that
the information is valid and the lack of signatures by all
team members and the coach will disqualify the entry.
of the Team Coach:_________________________________________
of Team Members:
We ask for the cooperation of the team coach in responding to the
following questions. This information will be used to determine how
and if the competition is meeting its goals, purposes, and audiences.
Submission of this information is voluntary. Failure to provide it
will not affect your team's chances for an award.
your community type (check one):
the number of student team members who are:
Black, not of Hispanic
Native American/Alaskan Native
White, not of Hispanic origin
the number of student team members that are:
Note: Mail one copy of
the complete entry. Faxed entry material will not be accepted. Entries
must be postmarked by February 3, 2014, or the entry will
be ineligible for the competition. Materials that do not meet the
rules and regulations will be disqualified. Permission is granted
to duplicate this Official Entry Form.
This is a printable form. When you have finished filling in the
blanks, press the print key and MAIL COMPLETED ENTRIES TO:
Christopher Columbus Awards
105 Terry Drive, Suite 120
Newtown, PA 18940-3425
Entry Form Instructions on previous page.