826CHI Teen Writers Studio 2017-2018 Application
Thanks for your interest in joining the 826CHI Teen Writers Studio for the 2017-2018 term! Please CAREFULLY complete this application by Monday, August 21st at 5PM. We look forward to hearing from you!

The Teen Writers Studio is a space for rising writers and leaders to meet, write, and work collaboratively. It's open to anyone in 9th-12th grade. In addition to attending the biweekly meetings, TWS members complete a 20-hour service requirement over the course of the school year by volunteering in 826CHI's After School Tutoring and Writing program and/or Weekend Workshops program.

TWS membership involves serving as an ambassador for 826CHI at literary events across the city of Chicago— members are expected to participate in at least two outreach events per semester. Service hours are awarded for outreach and community engagement.

Please note: We are looking for high school students who can make the commitment to the year-long program. TWS meets over the course of the entire academic year and works towards a culminating publishing project that builds on all workshop sessions. Students are allowed no more than two excused absences per semester.

--- PROGRAM DETAILS ---

WHAT: 18 workshop sessions starting 9/18/2017 and going until 6/11/2018.
WHEN: Every other MONDAY from 6:30PM-8PM.
WHERE: 826CHI, 1276 N Milwaukee Ave, Chicago, IL 60622.
WHO: 20 high school students in grades 9 through 12; TWS is led by Maria Villarreal, with support from 826CHI volunteers and guest writers.

THIS APPLICATION WILL CLOSE ON AUGUST 21, 2017.

Please contact Maria at maria@826chi.org with any questions.

First Name
Your answer
Last Name
Your answer
Secret Agent Name
Your answer
Your Gender
Optional Only
Race / Ethnicity
Check All That Apply -- Optional Only
School
Please write out the full name of your school.
Your answer
What is the primary language spoken in your home?
Your answer
Does your family qualify for free or reduced lunch?
Which neighborhood do you call home?
Your answer
What is your age and grade level?
Your answer
What do you hope to get out of your time with the 826CHI Teen Writers Studio?
Your answer
What role does writing play in your life?
Your answer
Can you tell us about a time when you had to take the lead on a project or situation?
Your answer
Who are your top 3 favorite artists, writers, thinkers, and/or social leaders?
Your answer
Tell us about a book or work of art / performance that has had a profound impact on your life.
Your answer
Do you participate in other groups or activities? Please describe.
Your answer
TWS members must complete 20 volunteer hours over the course of the 2017-2018 school year. Are you interested in volunteering at 826CHI programs?
Volunteer opportunities for TWS members include after-school tutoring and Saturday workshops.
Are you interested in serving as an ambassador for 826CHI at literary and youth events across Chicago?
TWS members are expected to participate in at least two extracurricular events per semester. Opportunities include: Chi Teen Lit Fest, Zine Fest, Chicago Youth Talks, Essay Fiesta, and more.
We'll be working on a book project throughout the year. Do you foresee any conflicts that would get in the way of your commitment to attending our meetings every other Monday?
Example: sports, babysitting, other commitments
Your answer
Have you participated in TWS (formerly known as the Youth Advisory Board) in the past?
Required
Review the following dates and check the dates you definitely CANNOT attend TWS:
This is a list of every TWS workshop session for the year. We realize you may not know your full schedule yet, but please let us know about conflicts you're aware of now.
Required
How do you plan to get to/from the 826CHI space on Mondays?
Your answer
Phone Number
The best number to reach you (student).
Your answer
Email Address
Student email address. This is VERY important— information about TWS will be communicated via email throughout the year. Please write your main email address, the one that you check regularly.
Your answer
Parent's Name
First name and last name.
Your answer
Parent's Phone Number
Your answer
Parent's Email Address
Your answer
Thanks for applying to TWS 2017-2018. Is there anything else you'd like to share with us?
Your answer
THE FOLLOWING QUESTIONS MUST BE ANSWERED WITH A PARENT OR GUARDIAN OVER 18 PRESENT:
Required
MEDICAL INFORMATION
Please list any existing medical conditions or allergies the student has including medication, food, and latex / material allergies. Please indicate the name and dosage of medication, vitamins, or herbal treatments the student is currently taking. Please notify us of any changes so we can follow up accordingly.
Your answer
MEDICAL RELEASE
I hereby authorize adult workers with 826CHI to consent to any examination, x-ray, anesthetic, medical or surgical diagnosis or treatment and hospital care which is rendered under supervision of any physician or surgeon on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. I also give my consent to transportation to a medical facility by ambulance or private vehicle; whichever is necessary in an emergency. Further, as parent or guardian of the named above, I do hereby expressly consent that my son/daughter may receive emergency medical treatment from any physician, hospital, or other medical center without the necessity of first notifying me, and do further agree to hold blameless any physician, hospital or other medical center for rendering such services. I release 826CHI and 826CHI employees from liability for injury or accident, and do give my permission to secure proper medical attention for above named minor should the need arise. I understand that I will be financially responsible for any expenses incurred due to medical care, travel expenses, etc. due to an accident or illness. I release 826CHI from any financial responsibility that may be incurred due to injury, accident or illness.
PHOTO AND VIDEO RELEASE
While your child (ren) is engaged in programming at 826CHI, he or she may appear in photographs, video or radio footage that 826CHI may wish to use in its promotional materials (which include the 826CHI fact book and website) or on the radio. These materials help provide the public with information about programs at 826CHI, allow students the opportunity to have their work aired on the radio, and are used to help 826CHI raise money to support the writing center and its programs. Please note that although permission for use of photographs, video or radio footage of your child is voluntary, once consent is provided by signing this form, it cannot be withdrawn. Also, 826CHI is a nonprofit organization and will not be able to provide monetary compensation. Please check "Yes, I Agree" below to grant permission to use the material. I hereby grant permission to 826CHI to use my child’s photograph, video and/or radio footage without further consideration. I acknowledge the organization’s right to crop, treat or edit, the photograph, radio or video footage at its discretion. I acknowledge that 826CHI may choose not to use the photo or material at this time, but may do so at its own discretion at a later date. I acknowledge 826CHI will not provide monetary compensation for the photographs or material.
INFORMED CONSENT AND LICENSE AGREEMENT
We ask your permission to reprint student work. Please select "Yes, I Agree" to the follow: This is an Informed Consent and License Agreement between you, the author ("Author"), and 826 for material to be published in a forthcoming 826CHI Book or in any publication associated with 826CHI or 826 National. The Author understands and consents that although participation in 826CHI is completely voluntary, once consent to publishing the work is provided by signing this form, it cannot be withdrawn. The Author understands and consents that 826 reserves the right to edit and publish the Author’s work in any manner in the 826 Collection and/or any other publication affiliated with 826CHI or 826 National. 826CHI also reserves the right to paraphrase or re-word passages during the editing process. The Author understands and grants 826CHI the right to publish Author’s work in all editions and version of 826CHI’s Collection or any publication associated with 826CHI or 826 National. The Author understands and consents that 826CHI and 826 National are non-profit organizations, and will not be able to provide monetary compensation. The Author warrants to 826CHI that he/she is its sole author and that he/she has full power to make this Agreement. If the author is under 18 years of age, his or her parent or guardian must sign below. I have read the above information, and hereby acknowledge and accept the terms and conditions set forth herein.
PLEASE ACKNOWLEDGE
826CHI is a creative writing and tutoring center, where students may come to work on and receive assistance with school or writing. Although students are encouraged to feel at home while in the center, they are also expected to be focused and to be respectful of their surroundings. We reserve the right to ask students we feel are being too disruptive to leave. Please understand that 826CHI is a tutoring center and should not be considered an alternative to day care or babysitting services. Parents are responsible for making any necessary arrangements for getting their child home immediately after programming ends. Select "Yes, I Acknowledge" if you have read and understood this statement.
PRIORITY ENROLLMENT STATEMENT
Please read our 826CHI statement regarding priority enrollment and check "Yes, I Agree." Priority Enrollment Statement: 826CHI provides free creative writing programs for young people. Because our programs are free, priority enrollment will be reserved for students who live in the City of Chicago and are from low-income families and/or English Language Learners. We ask that parents who enroll their children in our programs self-identify as low-income and/or have children who are ELL's. Our registration process is no longer "first come, first serve" in an effort to strive toward equity and access. Everyone, however, is welcome to apply to our programs.
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