Please submit this form by February 20th, 2015 to images@monroeccc.edu Editors: Ted Vassar and Nicholas Vanderpool
Images 2015 Submission Form Student/Staff Information Student Information Please list the following for contact purposes. This information will not be made public. We will send a copy of Images if your work is published; please provide your home address.
Last name: _______________________________________ First name: _______________________ MI: _____________ Address:_____________________________________________________________________________________________ City: _______________________________________ State: _____________________ Zip: _________________________ Student ID/Staff Title: __________________________________________________________________________________ MCCC Email: ________________________________________________________________________________________ Phone Number: (________) ___________-__________ Alternative Phone Number: (________) __________-__________
Title/Description of Your Work Student Information
Brief Biography Student Information We will include a brief biography of each contributor. Please provide the following information:
City of Residence:
________________________________________________________________________________________________________
Degree Program (e.g. Associate of Science, Graphic Design - Illustration, Associate of Fine Arts): ____________________________________________________________________________________________________________________________
Future Career Goals: