What is your name?

How old are you?

What grade are you in?

1. Please write or draw anything you would like the judge to know about how you feel because of what has happened to you. You may want to write about anything that has changed in your life or in your family. You can even tell a story or write a poem if you would like. You can add more paper if you run out of room.

2. Please write or draw anything you want the judge to know that may be different at school, in your neighborhood or with your friends because of what has happened to you. You can add more paper if you run out of room.