DARE Essay Submission Form

 Officer’s Name:______________________    Dept:_____________________________

 Student’s Name:______________________  School:___________________________

 Parent’s Name(s):_______________________________________________________

 Officer’s Contact Number:________________________________________________

 Please fill this out for every DARE essay you submit and mail a copy of the essay and this form to:  Officer Mary Zimmerman  PO Box 337 Rossville, Kansas 66533.  If you have questions Officer Zimmerman can be reached at 785-584-6047 or 785-556-0938. 

***All essays need to be received by Officer Zimmerman no later than June 1, 2009.**