Permissions Form

First Name: Last Name:

OWC Student ID:

Email Address:

Phone Number:

Street Address:

City: State: Zip:

Contributor's Note:

In the space provided below, please write a short contributor’s note to use with your piece if we decide to publish it.

Your name should appear in the biography as you would like it to appear in print.  The bio should be written in the third person and limited to one or two sentences, such as the following:

Joe Cool is a collegiate high school student studying computer science. He plans to attend the University of Oregon and study journalism. 

Longer bios may be edited for space.

By clicking the Submit button below, I hereby give Blackwater Review the right to publish my prose or poetry piece(s). Note: We will publish your work using the name you provide on this form.