Submission Form

I’m sorry that this is not printable as is. You will need to copy and paste this into a word file and then print it. Thank you :-)


Michael Eric Mullaly Whispering Pines Scholarship

Submission Form


Please print and fill out (or type and print out) the following form and mail it with your submission which MUST BE RECEIVED by SATURDAY, NOVEMBER 25, 2017.

Phone number:
E-mail Address (PLEASE PRINT):
Twitter handle (if applicable):
Facebook name (if applicable):
Do you have an agent?
If yes, please tell us who it is:
What agency is he/she affiliated with?
Genre of your submission:
Title of your submission:
Have you’ve self-published any books? If so, which ones?

100 word bio:



Why do you write for children?



Please mail a complete picture book text, PB dummy, or the first 10 pages of a longer work. (No synopsis please)

These must be formatted with a:

• 1-inch margin all the way around,
• 12 point font
• Must be double-spaced.

Also, please remember:

• Please remember to include your registration form.
• Please mail your submission/registration form to:
Jenny Bagdigian
13 Evelyn Rd
Stow, MA 01775