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GIRLS WRITE NOW

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					MENTEE APPLICATION 2009–10
Applications are due by September 15, 2009 and will be reviewed on a rolling basis. Early applications are strongly encouraged.
Please mail, fax, or email completed applications to: GIRLS WRITE NOW INC. 520 Eighth Ave., ste. 2020 New York, NY 10018 Fax: 212.675.0171 beamentee@girlswritenow.org *Pages 4 and 5 must be either faxed or mailed.

Date of application: ___________________________ Name:______________________________ Nickname:__________________________ Street Address:__________________________________________________________ City:________________________________________ State:_____ Zip:____________ Home Phone Number ( _______) _________________ Other Phone Number ( _______) _________________ Type of Phone Number (e.g. your cell; a parent’s cell; a relative’s home, etc.) _____________________ Email:____________________________________ Date of Birth (including year): _______________ School you attend: _______________________________________________________ Grade (for Sept. 2009-June 2010 school year): ______________ School Address: _________________________________________________________ Name of Principal: __________________________ English Teacher, Spring 2009: _____________________________________________ English Teacher, Fall 2009: ________________________________________________

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How did you hear about Girls Write Now? _______________________________________________________________________ Do you have any health conditions we should be aware of? (If yes, please describe): ________________________________________________________________________ Citizenship (put an “x” in the box for all that apply): ____ US Citizen ____ US Permanent Resident ____ Not a US Citizen, Country of Citizenship __________________________________ Where were you born (City, Country)? ________________________________________ If you weren’t born in the U.S., when did you move here? _______________________ Ethnic Background (put an “x” in the box for all that apply): ____ ____ ____ ____ African American/African/Black ____ Asian Caucasian/White ____ Chicano/Mexican American Hawaiian/Pacific Islander ____ Hispanic/Latino Native American/American Indian/Alaskan ____ Other (specify:_____________)

Religion (optional): ________________________________________________________ Language Proficiency: Is English your first language? ________________________________________________ What is your primary language? ______________________________________________ Which languages, other than English, do you speak fluently? _________________________________________________________________________ Brief description of yourself: _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Why are you interested in joining and what do you hope to get out of the program? _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ What kind of writing do you like to do outside of school and why (e.g. poetry, fiction, playwriting, journalism, essay writing, etc.)? _________________________________________________________________________ _________________________________________________________________________ What kinds of things do you like to read and why? _________________________________________________________________________ _________________________________________________________________________

Girls Write Now Inc. | 520 Eighth Avenue | New York, NY 10018 www.girlswritenow.org | 212.691.6590 x.202 | 212.675.0171 fax | info@girlswritenow.org

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What are some of your extra-curricular activities for the 2009-2010 school year and any other hobbies? _________________________________________________________________________ _________________________________________________________________________ Have you won any contests, awards, scholarships, internships, etc. you would like us to know about? _________________________________________________________________________ _________________________________________________________________________ Are you available to meet with a mentor for one hour each week from September 2009 through June 2010? ________________ Are you available to meet with the group for five hours one Saturday per month? _____________ Do you have regular access to email: at home? _________ at school? _________ If we cannot accept you into the program at this time, would you still be interested in participating in larger community events? _____________________________________ If you are older than 19 and in college, are you interested in being a mentee intern? _____________ Please include ONE WRITING SAMPLE of any genre of any length (but no longer than 5 pages) on a separate piece of paper, in the body of an email, or in an attached Word document. We just want to see what your writing is like!

Girls Write Now Inc. | 520 Eighth Avenue | New York, NY 10018 www.girlswritenow.org | 212.691.6590 x.202 | 212.675.0171 fax | info@girlswritenow.org

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PARENT/GUARDIAN CONSENT FORM PLEASE SIGN AND RETURN TO GWN FOR RETENTION
Program Description: Girls Write Now is a nonprofit volunteer mentoring organization that conducts regular one-toone mentoring sessions, monthly group workshops, college prep. events, and public readings, with teenage girls (“the mentees”) and professional women writers (“the mentors”). The program is intended to assist girls in developing their creative writing skills, building selfconfidence, and making healthy choices in school, career, and life.

I, the parent/guardian of ________________________________ (“my child”), hereby give my permission for my child to take part in the Girls Write Now mentoring program described above. I understand that the following conditions apply: a) I understand that my child is fully responsible for her actions and behavior at all times during her involvement in the mentoring program. b) I verify that my child is physically and mentally capable of participating in the Girls Write Now program. I have indicated below any permanent or temporary medical or other condition(s), including special dietary and/or medication needs, which should be known to Girls Write Now and any medical provider who may provide treatment to my child: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ c) In the event of any injury or illness suffered by my child, I authorize Girls Write Now or any its representatives or mentors, to act on my behalf and to obtain any necessary medical treatment for my child at my expense. d) In an emergency I can be reached at the following phone number(s): (Please list home, work, and/or cell phone numbers) Name and phone number(s) of additional emergency contact:

Girls Write Now Inc. | 520 Eighth Avenue | New York, NY 10018 www.girlswritenow.org | 212.691.6590 x.202 | 212.675.0171 fax | info@girlswritenow.org

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PUBLICITY RELEASE for MENTEES Please sign and return to GWN for retention I,_______________________________, parent/guardian of ______________ (“my child”), understand that while my child is involved in the Girls Write Now mentoring program there may be written materials published, photographs taken, voice recordings made, or other records made of my child’s image or likeness, including the publication of my child’s name, for the purpose of promoting or publicizing the mentoring program and/or disseminating work prepared by my child. Some or all of these materials may be published on paper, on the Girls Write Now website, or through other form of electronic media. I expressly permit my child’s image, likeness, and/or name to be used by Girls Write Now in connection with publicizing or promoting the Girls Write Now mentoring program and/or disseminating any work prepared by my child. I further understand that neither I nor my child shall be entitled to any compensation or anything of value in connection with the use or dissemination of my child’s image, likeness, or name by Girls Write Now and/or any of its representatives, officers, employees, agents, and/or mentors.

(Signature/Relationship with Child)

(Date)

Girls Write Now Inc. | 520 Eighth Avenue | New York, NY 10018 www.girlswritenow.org | 212.691.6590 x.202 | 212.675.0171 fax | info@girlswritenow.org

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OPTIONAL TEACHER RECOMMENDATION FORM
___________________ is applying for admission to Girls Write Now (“GWN”), a nonprofit organization that matches high school girls committed to growing as writers with women professional writers who serve as their personal mentors for one full academic year and for up to four years. Girls meet with mentors one-to-one for at least one hour once a week. They also meet with the GWN community for one full-day Saturday workshop per month and for college prep. events and public readings throughout the season. Most meetings take place at GWN, 520 8th Ave., b/t 36 & 37 Streets in Manhattan, and girls are responsible for their own transportation. They are required to build a 7-genre writing portfolio, submit to contests, participate in at least two public readings, and get published in our annual anthology. They also have access to college prep counseling, cultural field trips, and countless scholarships and writing opportunities. Recommender’s Name: ___________________________ Email: __________________________________________ Phone #: __________________________

1. How long have you known the applicant and in what subject have you taught her? 2. How would you evaluate the applicant’s reading level? 3. How would you describe the applicant’s oral communication skills? 4. How would you describe the applicant’s written communication skills? 5. How would you describe the applicant’s interest in writing? In your opinion, is she committed to learning about and experimenting with writing? 6. Does the applicant have regular attendance, arrive on time, follow through with commitments, and meet homework deadlines? 7. As far as you know, will the applicant be able to meet at GWN weekly and monthly from Sept. 2009-June 2010? How would you describe the applicant’s ability to stay in regular communication with her teachers and advisors? 8. Does the applicant work well in groups and cooperate in the classroom? 9. Please provide any additional information or comments regarding the applicant. Feel free to use an additional page. 10. Should the applicant be accepted, are you available to be a liaison between GWN and the student?

Girls Write Now Inc. | 520 Eighth Avenue | New York, NY 10018 www.girlswritenow.org | 212.691.6590 x.202 | 212.675.0171 fax | info@girlswritenow.org

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Thank you very much for your interest in Girls Write Now. We appreciate your thoughtful attention to these questions.
Applications are due by September 15, 2009; early applications are strongly encouraged.
Please mail, fax, or email completed applications to: GIRLS WRITE NOW INC. 520 Eighth Ave., ste. 2020 New York, NY 10018 Fax: 212.675.0171 beamentee@girlswritenow.org *Pages 4 and 5 must be either faxed or mailed. If your application is accepted, we will call you for an interview.

Girls Write Now Inc. | 520 Eighth Avenue | New York, NY 10018 www.girlswritenow.org | 212.691.6590 x.202 | 212.675.0171 fax | info@girlswritenow.org

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