LLR Submission Form

The Lincoln Land Review lincolnlandreview.org

All submissions should be sent via email to: lincolnlandreview@llcc.edu In addition, this form must be completed and returned to the Arts and Humanities Department in 2249 Menard Hall.

SUBMISSION INFORMATION Title: Author’s Name: Male/Female Course and semester for which this was completed: Instructor’s Name: Address Where You Could Be Reached for the Next Year:

Street Address

City

Phone:

Email:

Hometown:

High School Attended:

LINCOLN LAND STUDENT INFORMATION Student ID #:______________________

Degree Pursued:

Major:

Dates of Attendance:

Hours Completed:

State/Zip

AUTHOR INFORMATION Further Education/Career Goals:

Family/Marital Status/Children:

Interests/Hobbies:

RELEASE STATEMENT I. I hereby give the Lincoln Land Arts and Humanities Department permission to consider my work, entitled,

, and to

publish it in the Lincoln Land Review if it is selected by the editors. I affirm that it is my original work and that it has never appeared elsewhere in print. I understand that the editors of the publication reserve the right to select and correct submissions.

Date

Signature

II. Lincoln Land Community College has my permission to include my name and community in any news releases concerning The Lincoln Land Review. Furthermore, LLCC may send a release to my community newspaper.

Newspaper Title

Date

City

Signature

III. I agree to LLCC posting my work on the Internet on LLCC-sponsored blogs, listservs or its homepage.

Date

Signature