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Participant Information Form for Rhode Island Students Respond to The Secret Life of Bees, a novel by Sue Monk Kidd for students in grades 6 to 12

Please print and complete this form then mail to the address below.
This information sheet must be attached to your response.

Name: __________________________________________________________________
(First Name, Middle Initial, Last Name)

Address: __________________________________________________________________

City, State, Zip Code: __________________________________________________________________

Parent or Guardian’s Name: ___________________________________________________

Home Telephone Number: __________________________

School: _______________________________ City/Town: _____________________

Grade: _________ English Teacher: _____________________

Note: The Reading Across Rhode Island project committee will not be able to return your original work:

· Please submit copies of any videos or cassettes.
· Please photograph any visual art and submit the photo, not the original artwork.
· Please keep a copy of any written response.
Thank you.

Please read & sign the following statement:
I certify that this written response, visual art, videotaped performance, musical recording or compilation represents my own original ideas about The Secret Life of Bees by Sue Monk Kidd. With the exception of compilations, all material was written or created entirely by me. Editorial assistance provided by classroom teachers, parents, or other youth leaders is permitted.

Reading Across Rhode Island has my permission to publish, share or exhibit this submission on the website or at a RARI event.

I understand that the Reading Across Rhode Island committee will not return any work submitted by me.

Signature: _________________________________________________

Date: _________________________

Please return all student responses to:
Cheryl Space
Coordinator of Children’s Programs
Providence Public Library
225 Washington Street
Providence, RI 02903

Please note: All entries must be postmarked by April 10, 2004.
Each student’s response must include a participant information form.

More details about Students Respond, Activities or Teachers.