Fifty Pairs of Eyes application Fifty Pairs of Eyes: Creating Characters in Fiction, Non-Fiction and Poetry Please complete the following online application. If you have any questions or experience technical difficulties please email staff@CollegevilleInstitute.org. Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Suffix Preferred first nameAffiliated Institution/EmployerPosition TitleCurrent 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?*Tell us something about yourself beyond what we learn from your resume.*Who’s a character you write about, want to write about, or have avoided writing about? Please tell us about that character in no more than 300 words.*Who’s a character from a written text — a novel, a poem, a memoir, Scripture — who has stayed with you, as a companion, or an irritant, or a goad? Please tell us about that character in no more than 100 words.*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 us with 7-10 pages of contiguous and double-spaced pages Drop files here or Select files Accepted file types: pdf, doc, docx, 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.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 Roslyn Center. We expect all participants to join in the full length of the workshop, and to reside at the Roslyn Center throughout the entire term (Monday, October 27 – Saturday, November 1, 2025). Do you have any scheduling conflicts that would prevent your full participation? If so, please note here.I understand that, if accepted, there will be advance reading (no more than 75 pages) and 3-5 pages of writing due by October 15 in preparation for the workshop. I am willing to do this groundwork.yesnoDid 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.Financial NeedTransportation to and from the workshop location (Roslyn Center, Richmond VA) is the responsibility of participants. Participants may be eligible to receive financial assistance to offset travel expenses. If you are not in need of financial support, we will then be able to assist more people who do.I would like to apply for financial assistanceFinancial assistance (maximum $500) is offered to help pay for travel and/or en route lodging. noyesPlease state your financial need (ex. en route overnight lodging, travel expenses) and the amount for which you are applying.COVID-19 Vaccination RequirementThe Collegeville Institute requires all program participants to be fully vaccinated and boosted for COVID-19.I understand that the Collegeville Institute requires all program participants to be fully vaccinated and boosted for COVID-19.* Yes 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 CitizenshipWhat 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
