Please complete in black ink.

Teacher's Name:                                                                                                                                         

                                                    LAST                                                                                              FIRST

Home Telephone: (         )__________________ School Telephone: (       )  ___________________

                                     Area Code                                                                                               Area Code

District:                                                                                                                                                         

School:                                                                                                                                                          

School Address:                                                                                                                                          

1.   Attached find Entry Forms for:  (Please indicate number in each category)

      ELEMENTARY  (Please note: 2 poster entries per number of fourth and/or fifth grade classrooms per category per school)

                                        Individual Poster                                                      Group Poster

      JUNIORS  (Please note: Maximum of 5 per category per school)

                                        Paper                                                        

                                Individual Exhibit                                                    Group Exhibit

                                        Individual Performance                                          Group Performance

                                        Individual Documentary                                        Group Documentary

                                        Individual Website                                                   Group Website

      SENIORS  (Please note: Maximum of 5 per category per teacher)

                                        Paper                                                        

                                Individual Exhibit                                                    Group Exhibit

                                        Individual Performance                                          Group Performance

                                        Individual Documentary                                        Group Documentary

                                        Individual Website                                                   Group Website

2.   Attached find a school check or money order (personal checks will NOT be accepted) covering

      ENTRY FEES FOR                                       STUDENTS

                                                         X $40.00 per student

      Total Amount:           $                           

      Payment is to be made for EACH STUDENT participating.   School check or money order

      is payable to:  LOS ANGELES COUNTY OFFICE OF EDUCATION        

FEES WILL NOT BE REFUNDED

     Mail or JET to:                                                                 or drop off package in person

      Michelle Herczog, Ed.D., HISTORY DAY L.A.             Michelle Herczog, Ed.D.

      Los Angeles County Office of Education                                Los Angeles County Office of  Education

      Curriculum and Instructional Services                           12830 Columbia Way., Room 236

      9300 Imperial Highway, ECW-236                                 Downey, CA  90242

      Downey, CA  90242-2890

ENTRY MATERIALS MUST BE RECEIVED NO LATER THAN 4:00 P.M. FEBRUARY 4, 2011

All Rights Reserved Copyright 2008. History Day L.A. Webmaster Amanda Roraback