Epiphany Entry Form - Weber State University

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Epiphany Entry Form

First and Last Name:
Date of Entry

Categories of Entry:	Titles of Works Entered
Short Fiction
Flash Fiction
Non-Fiction
Creative Non-Fiction
Poetry
*Please include title in heading of each page of work, number pages of your submission. Do NOT include author’s name on individual manuscripts.

Under which do you qualify as a Nontraditional Student (chack all that apply)	25+ years in age Married Parent

Address:
City:
State:
Zip:
Phone Numbers	Mobile: Home:
Email:

Weber State University
Ogden, Utah 84408