Literature / Prose / Poetry Consent Form

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Literature / Prose / Poetry
Consent Form
Student Eligibility and Guidelines:
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Open to all MDC students who are currently enrolled in any course at Kendall Campus.
Entry forms must be filled in its entirety.
All prose and poetry entries must be attached to this form.
A hardcopy and electronic copy (disk) must be included with this form.
Hardcopies must be typed, double spaced, in a 12 point regular font.
 Poems
250 words
 Essays
750 words
 Short Stories
2,500 words
Name:
Mailing Address:
Address
City / State
Zip Code
Telephone:
Home
Work
Cell
Other
[ ] Poetry
[ ] Short Story
[ ] Nonfiction
[ ] Essay
E-Mail:
Title of Work:
Please Check One:
Consent: If any work(s) submitted along with this form is selected for publication in Miambiance, I consent to first serial
rights on my submission to be used in Miambiance Magazine, for one (1) year from the time of publication. I understand that the
work cannot be submitted to be published in any other publication for the period above mentioned. I attest that it is entirely my
work and that I have been enrolled as a student at Miami Dade College – Kendall Campus during the semester it was submitted.
I hold Miami Dade College harmless for the contents of my work(s). I understand that editors may edit my piece for grammar
and mechanic, change the title, or have the piece illustrated. Art and photography may be used to illustrate text unless otherwise
specified by the artist.
Signature:
Date:
Turn in your submission along with this form to: Miambiance Submissions Mailbox located at the English &
Communications Department in room 2217. If you have any questions please contact:
 Professor Marta Magellan / Room 2217-01 / 305-237-2931 / [email protected]
 Professor Ricardo Pau-Llosa / Room 2218-31 / 305-237-2510 / [email protected]
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