Please make copies of this tally and voting form. Use a separate tally sheet for each category.

The following votes are for: _____ Picture Books _____ Grades 4-6 _____ Grades 6-9 ______ High School

Please type or print.
List� in alphabetical order, by author's last name, all titles for which you are casting votes.
Entering votes by grade level on the tally is optional.
Enter the total votes for each title for which votes are cast. THIS IS ESSENTIAL.

Titles                           Grades                                              Totals

Person Completing Form:____________________________  Position:__________________

Name of School:____________________________________   Phone:____________________

Address:____________________________________________________________________

e-mail address_________________________________________________________________

Tally must be received no later than April 25.

Please send to:
Maryland Black-Eyed Susan Book Award
P.O. Box 21127, Baltimore, MD 21228

or

contact , Chair