THE
L OS A NGELES S UMMER I NSTITUTE
P ART ICIPANT A PPLICAT ION FOR A DMISSION
I wish to participate within the following genre (circle one only):
Fiction
Creative Nonfiction
Poetry
Screenwriting
Ms. Mrs. Mr. ___________________________________ Date of Birth: ___________________
Address: ______________________________________________________________________
Daytime Phone: (_____)________________ Evening Phone: (_____)_____________________
Email: ______________________________ Fax: (_____)______________________________
Emergency Contact Info (name and number): ________________________________________
Occupation: ___________________________________________________________________
Please list three choices for a workshop leader (faculty member) in order of preference:
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
Do you wish to participate in the mentorship program? ______
If so, please list three choices for a mentor in order of preference
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
Manuscript title(s) and genres of the work accompanying this form (Poets send up to 10 poems;
all others send 15-20 pgs. in particular genre):
________________________________________________________________________________________________________________________________________________
If you have published work, please list the title, genre, publisher, and publication date. (Use
additional paper if necessary.)
________________________________________________________________________________________________________________________________________________
A brief bio including current/future writing projects:
________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________
Red Hen Press § P.O. Box 3537 § Granada Hills, CA 91394 § (818) 831-0649 § [email protected]
4085ev.pdf
Have you participated in other writing workshops? ________
If yes, where? __________________________________________________________________
What do you hope to gain from attending the Los Angeles Summer Institute? (Use additional
paper if necessary.)
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Will you bring guests to the evening receptions/readings? _______
Name: ________________________________________________________________________
(Each guest, in order to attend the evening festivities, will be asked for $10 admission.)
Food sensitivities or allergies? ________ What types? __________________________________
Diet restrictions? _______ What types? _____________________________________________
Will you stay on the Mount Saint Mary’s campus? _________
If so, do you want double or single occupancy? ________________________________________
(Double occupancy shares a room and a bath.)
Do you plan to have a car on campus? _______________________________________________
How did you hear about the Los Angeles Summer Institute? (Please check all that apply)
_____ Poets & Writers
_____ The Writer’s Chronicle
_____ AWP Conference Material
_____ Website
_____ Other Red Hen Press connection (please explain): _________________________
_____ Other: ____________________________________________________________
Signature: ________________________________________ Date: _________________
Consideration and acceptance of applicants will be based on a first-come, first-serve basis
Applicants will be notified of acceptance status within 30 calendar days of receipt of application.
Please include a $25.00 application fee payable to Red Hen Press
Red Hen Press § P.O. Box 3537 § Granada Hills, CA 91394 § (818) 831-0649 § [email protected]
4085ev.pdf