Writer's Workshop - Writing to Change the World: A Week with Jonathan Wilson-Hartgrove - APPLICATION

In addition to completing this application, you must email to Andrea Bellarosaa - bellarosaa@macucc.org by the submission deadline June 10, 2017, the following documents:

1.  Writing Sample 2,000 Words or less

2.  Current Resume

Once you have emailed all of the documents, your completed application will be reviewed.  Applicants will be notified on a rolling basis.  You will be notified no later than July 15, 2017.

*Prefix/Suffix
*First Name
*Last Name
*Preferred Name
*Address 1
Address 2
*City
*State
*Zip
*Phone
*Email
Cell Phone
*Religious Denomination
*What interests you about attending this workshop?
*Please tell us something about yourself beyond what we learn from your resume.
*What do you hope to get our of this workshop for yourself? For your ministry?
*Tell us something about your own experience in writing?
*Emergency Contact Information (include name, relationship to person, phone number and address)
Name any physical restrictions or special needs you may have.
Name any dietary restrictions or special needs you may have.
*Photo Consent

I give Collegeville Institute for Ecumenical and Cultural Research and the Massachusetts Conference, United Church of Christ permission to use photographs of me for possible inclusion in the Collegeville Institute and MACUCC websites and/or written publications.  I grant the right to Collegeville Institute and the Massachusetts Conference to crop or adjust such photographs at their discretion, and to incorporate such photographs into any or all of their website or written materials, including, but not limited to, brochures, newsletters, pamphlets, and magazine advertisements.  

Yes
No

Optional Questions

Gender
D.O.B.
Ethnicity
Asian/Pacific Islander
American Indian/Alaskan Native
Black
Hispanic
Caucasian
Other
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