Waiting For Words Workshop Application Form Waiting for Words Workshop Application Form Please complete the following online application form. If you have any questions or experience technical difficulties please email staff@CollegevilleInstitute.org. Waiting for Words: An Advent Writing Workshop with Lauren Winner, December 4-8, 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 Primary phone*Secondary phoneWhat interests you about attending this writing workshop?*Describe the writing project you are currently working on (or, if in between projects, please describe the project you most recently completed) (no more than 200 words).*Tell us about the writing project you'd like to work on during this workshop (no more than 200 words).*Please submit up to a 2,000-word writing sample.*Max. file size: 50 MB.Please submit your most current resume/CV.*Max. file size: 50 MB.Please submit a recent headshot.Max. file size: 50 MB.Writing workshop preparation*I understand that there will be some advance preparation for this writing workshop (ie, reading and/or writing). I can commit to doing any required advance preparation. Yes No 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. Proof of Vaccination*Please upload a picture of the front and back of your current COVID-19 vaccination card. Drop files here or Select files Accepted file types: jpg, png, pdf, jpeg, Max. file size: 50 MB, Max. files: 3. In addition to the vaccination requirement, this workshop requires participants to have a negative day of COVID-19 test result before participating. I understand and can commit to this requirement if accepted into the program.* Yes No 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 (Avila Center, Durham NC) 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. 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: 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
