The Concord Review
                              Form to Accompany Essays   

	A check for $40 to The Concord Review must be sent with this form to help us meet 
	our expenses. You will receive the next four issues of the journal.  Mail one copy
	Mail one copy of this form (and a check for $40) with each essay submitted to:   

	The Concord Review 
	730 Boston Post Road, Suite 24 
	Sudbury, MA 01776 USA  
	(800) 331-5007 
	Email: fitzhugh@tcr.org 
	Web: http://www.tcr.org  
	
	BY SIGNING THIS FORM, THE AUTHOR AFFIRMS THAT THIS PAPER IS HIS/HER OWN ACADEMIC WORK.
	
	Author's Signature: ______________________________________________________________ 

	Author's Name: _________________________  E-mail Address: ________________________   

	Title of Essay: __________________________________________________________________  

	Home Address: ____________________________________________________________________   

	______________________________  City: ____________________ State: ____ Zip: ______   

	Home Phone: (____) ____ - ______  

	Year of Graduation: ______   Date of Birth (mm/dd/yy): ____/____/______   

	Name of School: __________________________________________________________________   

	School Address: __________________________________________________________________  

	______________________________  City: ____________________ State: ____ Zip: ______   

	School Phone: (____) ____ - ______   

	Name of History Teacher for whom essay was written: ______________________________ 

	Title of Course (if any) for which essay was written: ____________________________   

	Name of School Principal: ________________________________________________________  

	Name of History Department Chair: ________________________________________________   

	E-mail Address of History Department Chair: ______________________________________   

	Name and Address of Local Newspaper: _____________________________________________   

	__________________________________________________________________________________   

	______________________________  City: ____________________ State: ____ Zip: ______  

        Biographical Information (for the Notes on Contributors) -- Please provide information  
	on the author's background, any academic honors and interests, career goals, community 
	service, travel, internships, or other activities and achievements. Seniors, please let 
	us know your college or job, so that if your essay is printed next year, we will have 
	your location.  

	PLEASE USE THE SPACE BELOW FOR OUR NOTES ON CONTRIBUTORS   


















	__________________________________________________
	The Concord Review 
	730 Boston Post Road, Suite 24 
	Sudbury, MA 01776 USA  
	(800) 331-5007 
	Email: fitzhugh@tcr.org 
	Web: http://www.tcr.org