Test page Writing Workshops Application Please complete the following online application. If you have any questions or experience technical difficulties please email staff@CollegevilleInstitute.org. NOTE: Once you select a workshop title from the drop-down list below, the corresponding application fields will be displayed. Workshop InformationWorkshop title*Please choose the title of the workshop that you are interested in applying for; once you choose a workshop, the correct fields will populate in the application below.Exploring Identity and (Dis)belonging through the Personal Essay, Apr. 16-22, 2023Interfaith Writing Workshop by and for Women of Color, Jun. 19-25, 2023General 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 Gender Identity/Preferred Pronouns:*(needed for potential onsite housing assignments) Primary phone*Secondary phoneWhat interests you about attending this workshop?*Tell us something about yourself beyond what we learn from your resume.*Describe the writing project you are currently involved in, if applicable (no more than 250 words).*What does “(dis)belonging” mean to you?*What interests you about attending this workshop? What drew you to this?*Our goal is to assemble a diverse group of women of color from a range of faiths. How would you describe your identity and/or your background?*Tell us something about yourself beyond what we learn from your resume.*In one paragraph, describe the writing project you are currently involved in (or if you are in between projects, describe what you recently wrapped up or what you are envisioning as a future project).*Workshop pre-work*I understand that, if accepted, there may be advance reading and/or writing assignments in preparation for the workshop, and am willing to do this groundwork as expected. Yes No 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*(2,000 words or less, recent work) *(send by pdf or Word document) Drop files here or Select files Accepted file types: doc, docx, pdf, Max. file size: 50 MB, Max. files: 4. Writing sample*(1,500 words or less, recent work) *(send by pdf or Word document) Drop files here or Select files Accepted file types: doc, docx, pdf, Max. file size: 50 MB, Max. files: 4. Writing sample*Writing sample (10-15 pages of sustained creative nonfiction or fiction prose)*(send by pdf or Word document) 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.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 workshop location. We expect all participants to join in the full length of the workshop. Do you have any scheduling conflicts that would prevent your full participation? If so, please note here.Scheduling conflicts?Please double-check your calendar regarding the workshop dates you have chosen. We expect all participants to join in the full length of the workshop. Do you have any scheduling conflicts that would prevent your full participation? If so, please note here.COVID-19 Vaccination RequirementThe Collegeville Institute requires all program participants to be fully vaccinated and boosted for COVID-19.COVID-19*I understand that the Collegeville Institute requires all program participants to be fully vaccinated and boosted for COVID-19. Yes Did you apply or register for another 2023 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. Focus FellowshipDue to the virtual nature of this workshop, writers may be eligible to receive a $500 Focus Fellowship to be used in a way that removes barriers to their participation (ex: childcare, lodging, meals). This fellowship is intended to create access and free-up more time during the week for participants to engage fully in the online workshop.I am applying for a Focus Fellowship.* Yes No How do you plan to use the Focus Fellowship to help you to engage more deeply in the workshop?*For example, the fellowship funds could be used to order-in meals so that participants can spend less time in the kitchen and more time writing. Or the funds could be used to support child-care expenses during the week. Or a participant could rent a quiet cottage so as to better concentrate during Zoom sessions. 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 CitizenshipIf you prefer not to answer, please leave this answer blank. 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
