2018INTERNATIONAL WRITER’S PROGRAM (IWP) APPLICATION

PART I: Biographical Information

Full Passport Name

First Name

Family Name

Middle Name(s)

Pen Name (if applicable)

Date of Birth

Format: mm/dd/yyyy

Gender

Female

Male

Passport Number

Issuing Country

Passport Expiration Date

Format: mm/dd/yyyy

*Passport must be valid throughJune next year.

City of Birth

Country of Birth

Country of Citizenship

Country of Current Residence

Country of Permanent Residence

Primary Address

Mobile Number

Primary email Address

English language proficiency

Excellent

Good

Poor

None

Other Languages

Occupation

Employer

Other Concurrent Jobs (if applicable)

Have you previously been to the University of Iowa?

Yes

No

Have youbeen in the U.S. in J-1 or J-2 status?

Yes

No

If yes, please provide details on the purpose and duration of travel.

Purpose / From
Format: mm/yy / To
Format: mm/yy

Are you a graduate of a foreign (non-U.S.) medical school?

Yes

No

Mark all genres that apply to you:

Fiction / Poetry / Creative Nonfiction / Playwriting / Screenwriting / Translation / Other

Book Publications:

Genre / Type / Original Title / English Title / Publisher / Year

Translation of work into other languages:

Genre / Type / Title / Language / Translator / Publisher / Year

Awards and Honors:

Name / Year / Other info (if applicable)

Writing residencies, conferences, or festivals attended, as well as any other professional travel/s:

Name / Year/s / Other info (if applicable)

Please list any collaboration with other writers or art forms.

Type / Name / Year/s

Please list any other related forms of literary engagement or involvement.

Type / Name / Year/s

Please provide any additional or valuable information related to your writing career or status.

Work sample(s) description:

Describe the piece being submitted, including the language of origin, biographical information on the translator, and, if applicable, publication information.

Please write a one page statement of interest (in English) addressing the following:

1) Why are you interested in participating in the program?

2) What do you plan to gain from the experience and how would it contribute to the fulfillment of your professional plans?

3) How might you share this experience with others in Lebanon both in your work and in your community?

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