Science as Art Contest

Entry FormPage 1 of 2

Name UM School or College Uniqname Phone number

_________________________________________________________ ____________ Major___________ Class Standing______________ _________________________________________________________ _________________________________________________________

By submitting this Contest Entry Form, you are certifying that your entry represents your own artwork, which is original in concept, design, and execution and does not violate any other party’s rights. By submitting this Contest Entry Form, you are certifying that at least one of the following is true: (a) you hold the copyright for all material that is used in your entry; (b) you have been authorized as the agent of the of the copyright holder to have the material copied; (c) you have been granted a license by the copyright holder to reproduce the material; or (d) the reproduced material is in the public domain.

1. Is your submission your own artwork, original in concept, design, andexecution?

NO YES

2. Have you used any other party’s copyrighted material (music, images, written work,etc.) as part of your entry?

If you answered YES to Question 2, above, you must submit a signed copy of the Science as Art Permission/Release Form for Copyrighted Materials for each item and by each holder, by the submission deadline of January 20, 2017.

3. Have you incorporated any recognizable likenesses of person(s)?

If you answered YES to Question 3 above, you must submit a signed copy of the Science as Art Appearance Release Form for Use of Likenesses of Recognizable Person(s) by the submission deadline of January 15, 2016.

4. Written Explanation of ArtworkA written explanation must accompany each submission detailing both the: 1) scientific principle, concept, idea, process, or structure that is represented, and/or that served as the inspiration for the work and the 2) artistic components of the work.

Submit an attachment with your explanation of between 250–500 words at the same time you send this entry form. Be sure to label your written explanation with your name and the name of the work you are entering.

NO

NO YES

YES

6. AuthorizationI, hereby, authorize, in perpetuity, the Regents of the University of Michigan (“University”) to use, reproduce, distribute, publicly perform and display, and make derivative uses of my submissions. I understand that the University has no obligation to use my work.

Signature of Entrant:/s/______________________________ Date:______________________ Typing your name, following the /s/ shown above, is legally binding and attests to the accuracy of statements provided in this document.

5. Abstract

Submit a brief, self-contained descriptive abstract about your artwork. The abstract should be no more than 100 words in length. Consider including information about your motivation or inspiration, methods utilized, scope covered, etc. Your abstract may be displayed beside your work at the exhibition and/or used in other publicity about the contest.

Science as Art Contest

Entry FormPage 2 of 2