Fields with * by them are required.
Name: *
*
W#: *
*
Invalid
W########
Address:
City:
State:
Zip:
Invalid
Phone #: *
*
Invalid
###-###-####
Email: *
*
Invalid
Under which category do you qualify as a nontraditional student?
(Check all that apply)
*
25+ years old
Married (currently or otherwise)
Parent
Veteran
Disabled
I am not a Nontraditional Student and am submitting for the Diversity section.
Please select at least one qualification.
Title of Piece: *
*
Please select the category of your submission: *
Non-Fiction (Creative and Scholarly)
Poetry
Short Fiction
Flash Fiction
Community Engaged Learning
Please select at least one category.
Major:
Minor:
Class Standing:
Freshman
Sophomore
Junior
Senior
Artist Statement (100 words or less describing your piece):
How did you find out about Epiphany? *
Ad
Facebook
Friend
Nontrad Center
Teacher Announcement
Other
Please select at least one reason.
*
Checklist
Work title ONLY on piece (no personal information):
Yes
No
N/A
Additional pages titled:
Yes
No
N/A
Pages Numbered:
Yes
No
N/A
Works Cited:
Yes
No
N/A
Works Cited Format Used:
Upload document: *
*
By submitting, I agree to the terms set forth by the Epiphany Staff, and I agree that this submission is completely and entirely mine. *