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2009 Hurston/Wright Writing Workshop for Teens

Please print this form, complete it, and mail it to the address below.
Submission Deadline: June 22, 2009. (This entry form may be duplicated.)

Student Information

Last Name _______________________________________________________________

FIrst Name_______________________________________________________________

Address _________________________________________________________________

City_______________________________________ State______ Zip Code____________

Phone____________________________________E-mail__________________________

Date of Birth____________________Male___Female___

Name of School ______________________________________________________________

Address _________________________________________________________________

City_____________________________________ State_____ Zip Code_______________

Phone_________________________________________

Grade Level (as of May 2009)_________________________


Parent/Guardian’s Information

Name___________________________________________________________________

Address _________________________________________________________________

City_______________________________________State_______Zip Code____________

Daytime Phone ___________________________________________________________

Evening Phone____________________________________________________________

E-mail Address ____________________________________________________________


Writing Sample Information

Title of Work________________________________________________________________

No. of Pages_______________

Workshop Choices (Check One)

Poetry (including spoken word)

Fiction (prose/short story/novel/novella)

Playwriting (dramatic scenes written for the stage)

Have you attended Hurston/Wright Workshops before?
Yes Year(s) attended:_________________________
No

How did you find out about this workshop:
Teacher Internet
RHEMA Christian Church Other _____________________________________


Last book read for pleasure__________________________________________________________

Your Hobby(s)_____________________________________________________________________

Parent/Guardian of _____________________________ approves of the submission of this application and agrees that the decision of the Hurston/Wright Foundation and or judges will be final as to all matters, including eligibility, timelines of submission, and compliance with these entry rules and those of the Hurston/Wright Foundation.

Parent/Guardian Signature_______________________________________________Date____________

Print_______________________________________________________________________

Please type your name in lieu of signature

Hurston/Wright
Writing Workshop for Teens
12138 Central Avenue, Suite 209
Bowie, MD 20721
Ph. 301-459-2108
Email info@hurstonwright.org – Website www.hurstonwright.org