BH Student Entry Form Tool by Sm5dWLv

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									                                         National PTA Reflections® Program
                                    Student Entry Form Bower Hill Elementary 2012

                                               “The Magic of a Moment”
This form is to be used by students entering the PTA Reflections to gather necessary information for completing the official Online
Student Entry Process to advance to the next round in the National PTA Reflections Competition. This form is to be completed and
kept with the student entry and CD in legal size envelope.

Grade Level (Check one):                                            Arts Category (Check one):
       Primary (Preschool – Grade 2)                                       Dance Choreography
       Intermediate (Grades 3-5)                                           Film Production
       Middle School (Grades 6-8)                                          Visual Arts
       High School (Grades 9-12)                                           Photography
       Special Artist (Grades prek-12)                                     Literature
                                                                            Music Composition

STUDENT INFORMATION

Gender (Circle one):               Male                       Female

Student First Name:                                           Student Last name:


Parent Guardian Name:


Parent/Guardian Address:                                      City, State Zip:


Parent/Guardian Email:                               Parent/Guardian Phone:


SCHOOL/PTA INFORMATION

School Name:                                                           Homeroom # / Teacher:
Bower Hill Elementary, 424 Bower Hill Road, Venetia, PA 15367


PTA/PTSA Name (Provided by Reflections Program Leader):
Bower Hill Elementary PTA Unit ID# 00145787, Mary Lou Bulseco, bulseco145@comcast.net
ARTWORK SUBMISSION - Title:



Artist Statement (At least 10 words; maximum 100 words ,attach sheet if needed):




ARTS CATEGORY SPECIFIC QUESTIONS- Answer questions for the arts category relevant to your artwork submission.
Dance Choreography

1.   What is the title of the dance music?



2.   Who is the artist or musical group performing the music?



3.   What is the name of the composer?



4.   Who wrote the lyrics?



Film Production

1.   What is the brand and model of camera that you used?



2.   Did you use editing software? If so, what is the name of the software you used?



3.   Did you use background music? If so, what is the title of the music you used?



4.   Who is the artist or musical group performing the music?



5.   What is the name of the composer?



6.   Who wrote the lyrics?




7.   List the names of the people who appeared in this film.
Music Composition

1.   Does your composition include music for voice? If so, how many singers and what are their names?




2.   Does your composition include music for instruments? If so, what instruments?



3.   Did you use music composition software? If so, what is the name of the software you used?




Photography

1.   What brand and model of camera did you use?



2.   What kind of process did you use to prepare your photograph?



3.   For printed photographs, what are the dimensions of your picture? (No frames allowed.)



4.   If matted, what are the dimensions of your photo with matting? (No frames allowed.)




Visual Art

1.   Describe the medium or type of visual art you developed (e.g., crayons, collage, oil on canvas).



2.   What are the dimensions of your picture? (No frames allowed.)



3.   If matted, what are the dimensions of your photo with matting? (No frames allowed.)




QUESTIONS? CONTACT: Bower Hill Reflections Committee Chair- Mary Lou Bulseco, bulseco145@comcast.net

								
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