A completed entry form must accompany the essay. All applicable information MUST be completed, or the entry may be disqualified.

Name of Adult Author:
Home Address:
City:
State:     Zip:
Daytime Phone:
Email:

Visual Acuity: Must meet definition of blindness listed in the "Eligibility" section.
Do not list eye diseases. List a doctor's measure of your vision. List your corrected visual acuity WITH glasses or other lens.

Right Eye:
Left Eye:
OR Degree of restricted visual field:

Call 1-800-223-1839, ext. 356 with questions on how to list visual acuity.

Your age at the onset of your blindness:
Your age now:

This entry is sent from:
Agency/School    Home

Where should we send correspondence?
Agency/School    Home

Reading medium you prefer for correspondence:
Print    Braille

Agency/School Name:
Agency/School Address:
City:
State:     Zip:
Teacher's Name:
School Phone:
Fax:
Email:

Check the description that best fits you:
Adult consumer
Teacher or Rehab Counselor

Title of Essay:

Release: All essays submitted become the property of the American Printing House for the Blind. Entry in the 150th Anniversary Essay Contest implies permission for APH to edit, publish, or otherwise duplicate any essay entered into the contest without payment to the author. It also implies permission to release any information provided on the entry form and to photograph the author for publicity purposes during the fall awards ceremony in Louisville, Kentucky.

If you are going to submit your essay via email, you may send this entry form electronically by using this "Submit" button:

   

If you are using one of the other submission options, use the "Print Form" button or your browser's "Print" function to print this form. Mail the printed form with your disk to the address below.

   

You can also save the completed Entry Form and Essay on a disk and send the disk via regular mail. When sending a disk, clearly mark the outside of the envelope "Electronic Media" so it will not be scanned and erased.

Send entries to:
150th ANNIVERSARY ESSAY CONTEST (must be included on label)
Rebecca Snider, Public Affairs Department
American Printing House for the Blind
1839 Frankfort Avenue
Louisville, KY 40206

All entries must be received by April 1, 2008.