NASA SPACE SETTLEMENT DESIGN CONTEST ENTRY FORM

Please print this form after filling it and include it with your contest entry. If your entry is not associated with a school, enter your own adress, email and phone number instead.

 NAME OF STUDENT(S)

 GRADE AND AGE  
NUMBER OF STUDENTS  
 NAME OF THE SUBMISSION OR PROJECT  
TIME SPENT ON SUBMISSION
PARENT SIGNATURE FOR STUDENT NAME PLACEMENT ON WEB SITE AND USE OF ILLUSTRATIONS AND ARTISTIC RENDERINGS
TEACHER NAMES (IF APPLICABLE)  
NAME TO SEND CERTIFICATES TO  
E-MAIL CONTACT  
NAME OF THE SCHOOL (OPTIONAL)  
ADDRESS TO SEND CERTIFICATES TO

 street

street

city

state

countryzip code

 TELEPHONE NUMBER  
 DESCRIPTION OF CONTEST MATERIALS