2025 Apart and Yet A Part Online Application Form Apart, and Yet A Part Please complete the following online application. If you have any questions or experience technical difficulties please email staff@CollegevilleInstitute.org. Apart, and Yet A Part: A Workshop with Writing Coach Michael N. McGregorGeneral InformationName* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Suffix Preferred first name Affiliated Institution/Employer Position Title Current mailing address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Enter Email Confirm Email Primary phone*Secondary phoneWhat interests you about attending this workshop?*Describe the writing project you are currently working on or what you would like to work on while attending the writing workshop (no more than 500 words).*Tell us something about yourself beyond what we learn from your resume.*Resume or C.V.*Please provide us with a current resume or c.v. *(send by pdf or Word document) Drop files here or Select files Accepted file types: pdf, doc, docx, Max. file size: 50 MB, Max. files: 4. Writing sample*Please provide a writing sample of up to 2,000 words. Drop files here or Select files Accepted file types: doc, docx, pdf, Max. file size: 50 MB, Max. files: 4. PhotoPlease attach an (optional) photo of yourself.Accepted file types: jpg, png, jpeg, tif, Max. file size: 50 MB.Workshop preparation*There may be some advance preparation for this writing workshop (ie, reading and/or writing). Can you commit to completing the advance work? Yes No Scheduling conflicts?*Please double-check your calendar regarding the workshop dates you have chosen. The first and last days serve as travel days to and from the Collegeville Institute. We expect all participants to join in the full length of the workshop, and to reside at the Collegeville Institute throughout the entire term (June 5-14, 2024). Do you have any scheduling conflicts that would prevent your full participation? If so, please note here.Did you apply or register for another 2025 Collegeville Institute writing workshop? If so, which one(s)? How did you hear about the Collegeville Institute Writing Workshops?I am a past Collegeville Institute program participantReferral from a past Collegeville Institute program participantCollegeville Institute email/newsletterSocial Media (Facebook, Twitter, Instagram)Image Update Email NewsletterColleagueFamily or friendWebsite/search engineOther (please list below)OtherIf you answered "other" to the question above, please include details here. Which Collegeville Institute participant referred you?Please list the name of the past participant(s) who told you about the Collegeville Institute. What Collegeville Institute program(s) did you attend previously?Please list the name and year of all writing workshop, academic residency, fellows, congregational, or seminar programs you have participated in at the Collegeville Institute. COVID-19 Vaccination RequirementThe Collegeville Institute requires all program participants to be fully vaccinated and boosted for COVID-19.Vaccination status* I am fully vaccinated and boosted for COVID-19. I am not fully vaccinated and boosted for COVID-19, but will be before I arrive in person to participate in a Collegeville Institute program. I am not fully vaccinated for COVID-19 and do not plan to become vaccinated. This workshop may require participants to have a negative day of COVID-19 test result before participating. I understand and can commit to this requirement if required.* Yes No Demographic InformationThe Collegeville Institute strives to create programs and services that represent the full diversity of the human community. In addition, we strive to provide an environment in which every member of our community experiences a sense of belonging. We ask the following demographic questions to help ensure that we meet these goals and to get to know you better. The following questions are optional.Country of Citizenship What is your date of birth? (MM/DD/YYYY) Month Day Year Which of the following best describes you?Listed in alphabetical order; select all that apply. African American Asian Asian American Black African Latinx/Hispanic Middle Eastern Mixed Race/Multi-race Native American/Alaskan Native Pacific Islander/Native Hawaiian White/European Not listed here Prefer not to answer What is your present religious affiliation(s), if any?Listed in alphabetical order; select all that apply. Agnostic Atheist Baha'i Buddhist Catholic Christian Hindu Jewish Mormon Muslim Native/indigenous Other/prefer to self-describe Orthodox Christian Protestant Christian Secular humanist Sikhism Spiritual but not religious Prefer not to answer Please self-describe your religious affiliation(s). What type of Orthodox Church do you affiliate with? What Protestant denomination do you affiliate with? Gender Identity/Preferred Pronouns: Sexual Orientation:If you prefer not to answer, please leave this answer blank. Please describe any disability-related accommodations you need: Is there anything else regarding your identity/identities that you would like the Collegeville Institute to know about you and that would help us deepen your sense of belonging? Δ
