The Cupertino Educational Endowment Foundation presents The Lucretia Van Horn Memorial Art Award Entry Form • • Please use a PEN and print clearly. Tape this form to the back of your entry. ABOUT YOU Artist’s First & Last Name: ___________________________________________________________ Age: _______ Grade: ________ Male / Female: _________________ Parent or Guardian Name: __________________________________________________________ Home Address: __________________________________________________________________ City: __________________________ Zip Code: ____________________ Home Phone: ( ) Email: _______________________ Name of School: _________________________________________________________________ ABOUT YOUR ART Title of Artwork: ________________________________________________________________ Materials Used: __________________________________________________________________ Artist Statement: My artwork is about . . . ______________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ARTIST PLEDGE I declare and avow that the art I am submitting for consideration for this award is my original artwork. I am a student of a CUSD middle school and have entered a 2-D work of art for the theme, “Inner Strength.” My work is no larger than 18” X 20,” and will be turned into my school's art teacher by May 8th, 2015. I am only entering one work of art. Student Signature: _______________________________________________________________