Please complete this form and mail it, along with the writing samples and application fee, to Inez Schneider, New Member Coordinator, 4010 Singleton Road, Rockford, IL  61114. (815-877-9675)

Name __________________________________________________________

Address ________________________________________________________

City __________________________ State _______ Zip code _____________

Home phone _________________  Business phone _____________________

Email _______________________ Fax _______________________________

I have enclosed the following:

• the required two samples of my writing, as specified below
  
• a check or money order for $50, payable to The Writing Academy
  
• (optional) a one-page sample of my poetry, for which an additional $10 is added.

I understand the following: all but $30 of the application fee is nonrefundable. I will receive detailed critiques of my writing samples and, if accepted, a recommendation about how I should proceed in the Writing Academy curriculum. I will also receive first-year membership (at the New Member level), which will entitle me to receive all mailings to members and to enroll in specific courses at the designated costs. If I am not accepted, I will receive the critiques and a $30 refund.

           (Signature) _______________________________________

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Instructions for Writing Samples

Use standard manuscript format (double spaced in a clear, readable type), with your name, address, and telephone number in the upper left corner of the first page. Your name, an abbreviated title of the piece, and the page number should appear on each subsequent page.
First sample: Write 500 words or less, describing the part that writing played in your life, and the part you would like it to play in the future.
2nd sample: You may submit a published or unpublished sample of no more than 500 words of prose on any topic. Or if you prefer, you may write 500 words or less on one of the following suggested topics. 1. Write about a childhood event that significantly affected your life. 2. Write about a place that is important to you. 3. Write about an object that is important in your life. 4. Write about a teacher who deeply influenced you.

The above samples must be prose. If you would like to include a poem for critique by one of our poetry professionals, please add $10.00 to your fee.

When you apply--or before you apply--feel free to request more information about a particular course, our instructors, or critique partners.