Reflections Entry Form

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I affirm that this is my own original work.

Student signature____________________________

Parent signature_____________________________

Name__________________________________________________

Grade_________________ Age______________

Classroom Teacher_______________________________________

Grade Division: _____Secondary (Grades 3-5)

Arts Area: _____Literature ____ Dance Choreography

(check one) _____Musical Composition ____ Film/Video Production

_____Photography _____Visual Arts

Title of Work___________________________________________________

Artist Statement __________________________________________________________________________________________________________________________

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