Printable Application Form

Midwest Writing Center
225 East 2nd Street, Suite 303
Davenport, IA 52801
563-324-1410
[email protected]
www.midwestwritingcenter.org
MIDWEST WRITING CENTER
YOUNG EMERGING WRITERS SUMMER INTERNSHIP 2011
APPLICATION FORM
Name
Date of Birth
_____________________________________________________________________
Address
_____________________________________________________________________
_____________________________________________________________________
Home Phone _________________________Cell Phone _______________________
E-Mail
_____________________________________________________________________
Education
_____________________________________________________________________
_____________________________________________________________________
______________________________________________________________________________
Writing or Design
Experience___________________________________________________________
_____________________________________________________________________
______________________________________________________________________________
Work Experience
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
References:
1. ___________________________________________________________________
(Name)
(Position)
(Phone)
____________________________________________________________________
(Address)
(E-mail)
2.___________________________________________________________________
(Name)
(Position)
(Phone)
____________________________________________________________________
(Address)
(E-mail)
WRITING/DESIGN SAMPLES
PLEASE ATTACH TWO SAMPLES OF YOUR BEST WRITING OR PAGE DESIGN,
PUBLISHED OR UNPUBLISHED. YOU MAY INCLUDE A POEM, A FEATURE
ARTICLE, A SCHOOL ASSIGNMENT OR ANY OTHER WORK THAT SHOWS
YOUR WRITING ABILITY. PLEASE CONTACT THE MIDWEST WRITING
CENTER IF YOU HAVE ANY QUESTIONS ABOUT YOUR WORK SAMPLES.
Thank you for your interest in the Young Emerging Writers Summer Internship Program!