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Publishing Class Application
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Name
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Phone Number
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Artist Name (if different)
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Race/Ethnicity
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Gender Identity
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Age Range
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What is your highest level of education?
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What is your estimated annual income?
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Are you a protected veteran?
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Do you require any special accommodations?
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How did you hear about the CLI course?
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City, State
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Please identify which cohort you are applying to (1 application per cohort)
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Which Chapter are you interested in joining?
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Social Media Handles? (please indicate site for each name that applies)
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Do you attend open-mics or readings? (If so, please specify event or venue name)
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Please tell us about your writing journey. How long have you been writing? Why do you write?
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Writing Sample (Please submit 3 poems for Poetry or a short story/idea for Children's Books by writing or pasting here, separating poems by --- or ___ lines. Do not post web URL links.)
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Date
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