2011-2012 BOOKWORM SUBMISSION FORM Author's Name _________________________________________ Title _________________________________________________ Teacher and Grade ______________________________________ Date _________________________________________________ Signature of Teacher or Parent ______________________________ (Signature indicates that an adult helped proofread and edit this story and believes it to be of Bookworm quality for this student) Checklist (please make sure the following steps are all complete): Story is typed using MS WORD template from H&S Website Story has been proofread by author and an adult Copy/paste above information into the email, attach your story and email to montgomerybkwrm@comcast.net If you are unable to type/email the story, please contact Jaya Talluru For Bookworm Use Only: BOOK # __________________ All Stories must be submitted by: April 13, 2012