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.Writing Grief as Restorative Justice, Oct. 10-14, 2022General 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 FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin 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 work you are currently involved in or what you would like to work on while attending the writing workshop (no more than 500 words).*Are there specific loss experiences or other traumatic experiences that inspire your participation in this workshop? (no more than 500 words)*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*I understand that we are in a fluid public health situation. If this workshop is unable to proceed in person, I would be interested in attending it as a virtual writing workshop. Yes No Did you apply for another 2022 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
